Healthcare Provider Details

I. General information

NPI: 1336337872
Provider Name (Legal Business Name): ADEL ALY NADA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 W 96TH ST
INDIANAPOLIS IN
46260-1181
US

IV. Provider business mailing address

8315 E 56TH ST STE 120
INDIANAPOLIS IN
46216-1023
US

V. Phone/Fax

Practice location:
  • Phone: 317-407-5361
  • Fax:
Mailing address:
  • Phone: 317-337-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005490A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: