Provider Demographics
NPI:1760877161
Name:SILVA, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SILVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 S BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IN
Mailing Address - Zip Code:46035-9440
Mailing Address - Country:US
Mailing Address - Phone:765-601-2172
Mailing Address - Fax:
Practice Address - Street 1:8600 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3534
Practice Address - Country:US
Practice Address - Phone:765-601-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer