MEDICARE: DR. GODWIN O BIOKORO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05005175A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200673860	OTHER	IN	FIRST STEPS PROGRAM

General Provider Information

NPI Number	:	1063587301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GODWIN O BIOKORO PT

Provider Business Mailing Address
First Line	:	3025 E MICHIGAN BLVD
Second Line	:
City	:	TRAIL CREEK
State	:	IN
Zip	:	46360-6522
Country	:	US
Telephone Number	:	219-221-6331
Fax Number	:	219-221-6694

Provider Business Practice Location Address
First Line	:	3025 E MICHIGAN BLVD
Second Line	:
City	:	TRAIL CREEK
State	:	IN
Zip	:	46360-6522
Country	:	US
Telephone Number	:	219-221-6331
Fax Number	:	219-221-6694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/18/2008

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