Provider Demographics
NPI:1124212451
Name:DAFIAGHOR, ABEL E (DPT)
Entity Type:Individual
Prefix:DR
First Name:ABEL
Middle Name:E
Last Name:DAFIAGHOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4950 BROADWAY
Mailing Address - Street 2:STE G
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-4654
Mailing Address - Country:US
Mailing Address - Phone:219-712-9566
Mailing Address - Fax:219-884-3434
Practice Address - Street 1:4950 BROADWAY
Practice Address - Street 2:STE G
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-4654
Practice Address - Country:US
Practice Address - Phone:219-712-9566
Practice Address - Fax:219-884-3434
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002890A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist