Provider Demographics
NPI:1366748436
Name:HEALTH 1ST PHYSICAL REHABILITATION
Entity type:Organization
Organization Name:HEALTH 1ST PHYSICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, DC
Authorized Official - Phone:317-253-1644
Mailing Address - Street 1:6326 RUCKER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4889
Mailing Address - Country:US
Mailing Address - Phone:317-253-1644
Mailing Address - Fax:317-253-9708
Practice Address - Street 1:6326 RUCKER RD
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4889
Practice Address - Country:US
Practice Address - Phone:317-253-1644
Practice Address - Fax:317-253-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010034A225100000X
IN08001746A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty