Provider Demographics
NPI:1588859631
Name:MUKONA, ADONIAH MAVURA
Entity Type:Individual
Prefix:MR
First Name:ADONIAH
Middle Name:MAVURA
Last Name:MUKONA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ADONIAH
Other - Middle Name:MAVURA
Other - Last Name:MUKONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1801 RED PHISTER DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7172
Mailing Address - Country:US
Mailing Address - Phone:317-272-1383
Mailing Address - Fax:317-272-1992
Practice Address - Street 1:1801 RED PHISTER DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7172
Practice Address - Country:US
Practice Address - Phone:317-272-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004874A225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist