Basic Information
| Provider Information | |||||||||
| NPI: | 1750035317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEDRANO | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3146 LAWRENCE ST | ||||||||
| Address2: | |||||||||
| City: | HOBART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463421254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197898191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2775 VILLAGE PT | ||||||||
| Address2: | |||||||||
| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463040099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777873430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2022 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 06003642A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.