Healthcare Provider Details

I. General information

NPI: 1366098386
Provider Name (Legal Business Name): ALDRIN FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 87TH AVE
MERRILLVILLE IN
46410-6177
US

IV. Provider business mailing address

729 PINTAIL LN
HOBART IN
46342-9402
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-0744
  • Fax:
Mailing address:
  • Phone: 219-512-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005568A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: