| Organization Name: | INDIANA STATE UNIVERSITY |
| NPI Number: | 1063612257 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN HANIGAN (DIRECTOR) |
| Mailing Address: | 567 N 5th St Ss 172 Terre Haute |
| State: | IN US |
| Postal Code: | 478091903 |
| Phone Number: | 8122379613 |
| Fax Number: | 8122379612 |
| NPI Enumeration Date: | 07/25/2007 |
| NPI Last Update Date: | 07/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 05009329A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |