Southern Indiana Myofascial Release, LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

31005499A Issued in IN

Legal business name

SOUTHERN INDIANA MYOFASCIAL RELEASE, LLC

Practice address

101 NW 1St St Ste D
Paoli, IN 47454-1369

Phone

(812) 788-1118

NPI assigned

Aug 13, 2014

Last updated

Nov 2, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Brenda Jean Pardy, OTR/LNPI 1770549446

Title

Owner

Phone

(812) 788-1118

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brenda J Pardy, BS

  • Occupational Therapist
  • Paoli, IN
  • NPI 1770549446
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572652800000",
    "number": "1801295043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NW 1ST ST STE D",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474541369",
            "telephone_number": "812-788-1118",
            "fax_number": "888-371-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NW 1ST ST STE D",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474541369",
            "telephone_number": "812-788-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIANA MYOFASCIAL RELEASE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2019-11-02",
        "status": "A",
        "authorized_official_last_name": "PARDY",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-788-1118",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IN",
            "license": "31005499A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Indiana Community Health Care (Comprehensive Health Care)
• Southern Indiana Community Health Care (Comprehensive Health Care)
• Southern Indiana Community Health Care, Inc (Comprehensive Health Care)
• Southern Indiana Community Health Care, Inc (Comprehensive Health Care)
• Southern Indiana Eye Care, LLC
• John Steen, PA-C
• Brittany Renae Stout, FNP, NP-C
• Angela Dawn Stroud, OTR
• Joel Stroud, P.T.
• Heather Sturgill

• Rehabilitation Clinic/Center in Paoli, IN
• Providers in Paoli, IN by specialty
• Rehabilitation Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.