Provider Demographics
NPI:1770817207
Name:FAVOR, ARSENIO EUGENIO III (PT)
Entity Type:Individual
Prefix:MR
First Name:ARSENIO
Middle Name:EUGENIO
Last Name:FAVOR
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-3744
Mailing Address - Country:US
Mailing Address - Phone:219-947-1507
Mailing Address - Fax:219-942-3279
Practice Address - Street 1:4410 W 49TH AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-3744
Practice Address - Country:US
Practice Address - Phone:219-947-1507
Practice Address - Fax:219-942-3279
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009071A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist