Provider Demographics
NPI:1235354747
Name:UMENZE, PEACE EZIAMAKA (PT PHYSICAL THERAPIS)
Entity Type:Individual
Prefix:
First Name:PEACE
Middle Name:EZIAMAKA
Last Name:UMENZE
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
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Mailing Address - Street 1:5554 ROSEWOOD COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254
Mailing Address - Country:US
Mailing Address - Phone:317-295-1455
Mailing Address - Fax:
Practice Address - Street 1:8549 S MADISON AVE
Practice Address - Street 2:HCR MANOR CARE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:317-881-9164
Practice Address - Fax:317-887-4060
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05006610A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist