Basic Information
| Provider Information | |||||||||
| NPI: | 1598831844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUGLIESE | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSPT ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4850 W CENTURY PLAZA RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172162828 | ||||||||
| FaxNumber: | 3172162839 | ||||||||
| Practice Location | |||||||||
| Address1: | 6349 SOUTH EAST STREET US31 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177802005 | ||||||||
| FaxNumber: | 3177802006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05003428A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.