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General NPI Number Information
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NPI Number | 1124640487
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Entity Type | Organization
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Legal Business Name | WORK INJURIES PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/09/2020
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Last Update Date | 05/09/2020
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Provider Practice Location Address
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Address Line | 5265 COMMERCE BLVD
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City | CROWN POINT
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State | IN
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Zip | 46307-5326
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Country | US
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Telephone | 219-209-0472
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Fax | 888-727-6224
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Provider Business Mailing Address
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Address Line | PO BOX 11269
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City | MERRILLVILLE
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State | IN
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Zip | 46411-1269
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Country | US
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Telephone | 219-614-4501
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Fax | 888-727-6224
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ADMINISTRATOR
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Name | GANIYU AZEEZ
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Credential | PT
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Telephone | 219-614-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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