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NPI Code Detail

MEDICARE: NIMROD DARRYL REYES ABELLA LPT

MEDICARE: NIMROD DARRYL REYES ABELLA LPT
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
1225100000XPhysical Therapist070016068IL
2225100000XPhysical Therapist05010272AIN

General Provider Information

NPI Number : 1720253453
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIMROD DARRYL REYES ABELLA LPT
Provider Business Mailing Address
First Line : 3001 AMELIA CIR
Second Line :
City : JEFFERSONVILLE
State : IN
Zip : 47130-7635
Country : US
Telephone Number : 440-522-1140
Fax Number :
Provider Business Practice Location Address
First Line : 118 MEDICAL DR
Second Line :
City : CARMEL
State : IN
Zip : 46032-3323
Country : US
Telephone Number : 317-573-1037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2008
Last Update Date : 03/17/2018

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