Provider Demographics
NPI:1629492632
Name:INTERNATIONAL PHYSIOTHERAPY ASSOCIATES PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:INTERNATIONAL PHYSIOTHERAPY ASSOCIATES PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADONIAH
Authorized Official - Middle Name:MAVURA
Authorized Official - Last Name:MUKONA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:317-332-9552
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:317-272-1383
Practice Address - Street 1:3737 N MERIDIAN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4348
Practice Address - Country:US
Practice Address - Phone:317-672-9198
Practice Address - Fax:844-274-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN53000125A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy