Provider Demographics
NPI:1679878490
Name:BOLARIN, SUNDAY D (PT, MBA, MPM)
Entity Type:Individual
Prefix:
First Name:SUNDAY
Middle Name:D
Last Name:BOLARIN
Suffix:
Gender:M
Credentials:PT, MBA, MPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16838 GLEN CT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6841
Mailing Address - Country:US
Mailing Address - Phone:317-331-3872
Mailing Address - Fax:844-261-4997
Practice Address - Street 1:16838 GLEN CT
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46062-6841
Practice Address - Country:US
Practice Address - Phone:317-331-3872
Practice Address - Fax:844-261-4997
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004275A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist