Provider Demographics
NPI:1164023503
Name:GANIYU AZEEZ PT
Entity Type:Organization
Organization Name:GANIYU AZEEZ PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GANIYU
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-614-4501
Mailing Address - Street 1:PO BOX 11269
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-1269
Mailing Address - Country:US
Mailing Address - Phone:219-614-4501
Mailing Address - Fax:888-727-6224
Practice Address - Street 1:8691 CONNECTICUT ST STE C
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6239
Practice Address - Country:US
Practice Address - Phone:219-614-4501
Practice Address - Fax:888-727-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy