Healthcare Provider Details

I. General information

NPI: 1518167402
Provider Name (Legal Business Name): ROBERT OKWY ENYOBI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W 56TH PL
MERRILLVILLE IN
46410-2034
US

IV. Provider business mailing address

433 W 56TH PL
MERRILLVILLE IN
46410-2034
US

V. Phone/Fax

Practice location:
  • Phone: 219-980-2928
  • Fax:
Mailing address:
  • Phone: 219-980-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05003450A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: