| NPI | 1164475463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FATAI BOLAJI ADISA Administrator 219-313-0763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05005905A) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-08-22 |