| Doctor Name: | TANYA FONDEKAR |
| NPI Number: | 1679934764 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 05011795A |
| Business Practice Address: | 275 W 12th St 4 West Peru, IN - 469701638 |
| Business Phone Number: | 7654752160 |
| Business Fax Number: | 7654752164 |
| Mailing Address: | 1800 N Wabash Rd Ste 203, MARION |
| State: | IN |
| Postal Code: | 469521300 |
| Phone Number: | 7656513229 |
| Fax Number: | 7656513227 |
| NPI Enumeration Date: | 03/16/2016 |
| NPI Last Update Date: | 03/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 05011795A |
| 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 |