Maria Dolores Santos Menzen, PT | |
13723 Ravenwood Dr, Granger, IN 46530-4724 | |
(574) 339-4082 | |
Not Available |
Full Name | Maria Dolores Santos Menzen |
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Gender | Female |
Speciality | Physical Therapist |
Location | 13723 Ravenwood Dr, Granger, Indiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720319742 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 05006025A (Indiana) | Primary |
Provider Name | Paragon Outpatient Rehabilitation Services, Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1871867325 PECOS PAC ID: 8022272848 Enrollment ID: O20180926000250 |
Mailing Address | Practice Location Address |
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Maria Dolores Santos Menzen, PT 13723 Ravenwood Dr, Granger, IN 46530-4724 Ph: (574) 339-4082 | Maria Dolores Santos Menzen, PT 13723 Ravenwood Dr, Granger, IN 46530-4724 Ph: (574) 339-4082 |
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