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Contact Information

JIMMY MIDENCE, PTA
4205 SUNSHINE AVE
INDIANAPOLIS, IN46228
 Phone: 317-937-1134
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapy Assistant

225200000X
Indicates primary specialty

NPI Profile & details for JIMMY MIDENCE · (Male)

NPI # 1912558081
Status Active
Credentials PTA (Physical Therapist Assistant)
Entity Individual
Enumeration date 09/20/2019
Last updated 02/15/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 99094830A
  • IN Other 853356262 UHC
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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