Provider Demographics
NPI:1487757019
Name:DUNELAND REGIONAL REHABILITATION INC PC
Entity type:Organization
Organization Name:DUNELAND REGIONAL REHABILITATION INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DUNELAND REGIONAL REHABIL
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:SILLECK
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PTDPT
Authorized Official - Phone:219-696-5519
Mailing Address - Street 1:16382 MORTON PL
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1388
Mailing Address - Country:US
Mailing Address - Phone:219-696-5519
Mailing Address - Fax:
Practice Address - Street 1:16382 MORTON PL
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1388
Practice Address - Country:US
Practice Address - Phone:219-696-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN53000047A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200061430Medicaid
INCH3181OtherMEDICARE RR