MEDICARE: MR. SHUAIB ABIODUN TAIWO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	A5011322A	IN

General Provider Information

NPI Number	:	1861813560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHUAIB ABIODUN TAIWO PT

Provider Business Mailing Address
First Line	:	4994 OAKBROOK DR
Second Line	:	APT A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1166
Country	:	US
Telephone Number	:	317-704-4323
Fax Number	:	347-919-5546

Provider Business Practice Location Address
First Line	:	4994 OAKBROOK DR
Second Line	:	APT A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1166
Country	:	US
Telephone Number	:	317-704-4323
Fax Number	:	347-919-5546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2013
Last Update Date	:	12/23/2013

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