Healthcare Provider Details

I. General information

NPI: 1972572048
Provider Name (Legal Business Name): ANSELM NDUBUISI NWOSU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13352 BECKWITH DR
WESTFIELD IN
46074-8142
US

IV. Provider business mailing address

13352 BECKWITH DR
WESTFIELD IN
46074-8142
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-6955
  • Fax: 317-873-2123
Mailing address:
  • Phone: 317-529-6955
  • Fax: 317-873-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004706A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: