Healthcare Provider Details

I. General information

NPI: 1841655735
Provider Name (Legal Business Name): MINNIE ESCOBIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14902 SHELBORNE RD
WESTFIELD IN
46074-9668
US

IV. Provider business mailing address

14902 SHELBORNE RD
WESTFIELD IN
46074-9668
US

V. Phone/Fax

Practice location:
  • Phone: 317-286-2885
  • Fax: 317-536-3097
Mailing address:
  • Phone: 317-286-2885
  • Fax: 317-536-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: