Oscar Jerome III Hormillosa, PT
Individual provider Active NPI Physical Therapist · Brazil, IN
NPI 1801268461 · NPPES record last updated Jul 22, 2022
Key facts
- NPI
- 1801268461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 05011813A (IN)
- Practice address
- 15 Forest Park PLZ
Brazil, IN 47834-2737 - Phone
- (812) 420-1114
- Fax
- (812) 420-1115
- NPI assigned
- Oct 22, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036237 | NY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 036237 | NY | |
| Physical Therapist | 225100000X | 05011813A | IN | Yes |
Addresses
Primary practice location
15 Forest Park PLZ
Brazil, IN 47834-2737
Mailing address
619 E Springhill Dr
Terre Haute, IN 47802-4448
Phone (812) 232-3504
Other practice location 1
14902 Shelborne Rd
Westfield, IN 46074-9668
Phone (317) 286-2885
Other practice location 2
619 E Springhill Dr
Terre Haute, IN 47802-4448
Phone (812) 232-3504
Other providers in Brazil, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.