Provider Demographics
NPI:1033512355
Name:BABALE, ABOUBACAR
Entity Type:Individual
Prefix:
First Name:ABOUBACAR
Middle Name:
Last Name:BABALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5003
Mailing Address - Country:US
Mailing Address - Phone:517-402-7964
Mailing Address - Fax:
Practice Address - Street 1:2815 NORTHWIND DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5003
Practice Address - Country:US
Practice Address - Phone:517-332-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4221225200000X
MI5502004720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant