Provider Demographics
NPI:1265511604
Name:UNITED THERAPISTS, LLC
Entity Type:Organization
Organization Name:UNITED THERAPISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:BIOKORO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-689-3071
Mailing Address - Street 1:3025 E MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:TRAIL CREEK
Mailing Address - State:IN
Mailing Address - Zip Code:46360-6522
Mailing Address - Country:US
Mailing Address - Phone:219-221-6331
Mailing Address - Fax:219-221-6694
Practice Address - Street 1:3025 E MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:TRAIL CREEK
Practice Address - State:IN
Practice Address - Zip Code:46360-6522
Practice Address - Country:US
Practice Address - Phone:219-221-6331
Practice Address - Fax:219-221-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005175A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200726670 AOtherFIRST STEPS PROGRAM