Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 05006970 | IN |
NPI | 1003089350 |
---|---|
Provider Name | Timothy Adam Ebbert |
First Address | Carmel, IN 46032-5480 |
Second Address | Carmel, IN 46032-5480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 31/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000561450 | ANTHEM (01) | IN |
000000561450 | UNICARE (01) | IN |
200899220 | (05) | IN |
P00609673 | MEDICARE RAILROAD (01) | IN |