Doctor Name: | HENRICO MARC ENVERGA MADRID |
NPI Number: | 1205172269 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BSPT |
License Number: | 05008201A |
Business Practice Address: | 904 E 11th St Rushville, IN - 461731368 |
Business Phone Number: | 7659322974 |
Business Fax Number: | |
Mailing Address: | 7443 Hartington Pl, INDIANAPOLIS |
State: | IN |
Postal Code: | 462595805 |
Phone Number: | 3178621490 |
Fax Number: | |
NPI Enumeration Date: | 12/19/2012 |
NPI Last Update Date: | 12/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 05008201A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |