MEDICARE: NIKHIL MALIK P.T., C.E.A.S.

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	05008631A	IN

General Provider Information

NPI Number	:	1528341567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKHIL MALIK P.T., C.E.A.S.

Provider Business Mailing Address
First Line	:	9430 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-9768
Country	:	US
Telephone Number	:	219-616-6475
Fax Number	:

Provider Business Practice Location Address
First Line	:	9430 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-9768
Country	:	US
Telephone Number	:	219-616-6475
Fax Number	:

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

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/27/2011

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