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General NPI Number Information
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NPI Number | 1629492632
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL PHYSIOTHERAPY ASSOCIATES PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 3737 N MERIDIAN ST SUITE 210
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4348
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Country | US
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Telephone | 317-672-9198
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Fax | 844-274-0371
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Provider Business Mailing Address
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Address Line | 1801 RED PHISTER DR
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City | AVON
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State | IN
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Zip | 46123-7172
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Country | US
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Telephone | 317-272-1383
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Fax | 317-272-1383
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Authorized Official
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Title or Position | PRESIDENT & OWNER
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Name | DR. ADONIAH MAVURA MUKONA
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Credential | PHYSICAL THERAPIST
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Telephone | 317-332-9552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 53000125A
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License Number State | IN
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