Provider Demographics
NPI:1861813560
Name:TAIWO, SHUAIB ABIODUN (PT)
Entity Type:Individual
Prefix:MR
First Name:SHUAIB
Middle Name:ABIODUN
Last Name:TAIWO
Suffix:
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 1:4994 OAKBROOK DR
Mailing Address - Street 2:APT A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1166
Mailing Address - Country:US
Mailing Address - Phone:317-704-4323
Mailing Address - Fax:347-919-5546
Practice Address - Street 1:4994 OAKBROOK DR
Practice Address - Street 2:APT A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1166
Practice Address - Country:US
Practice Address - Phone:317-704-4323
Practice Address - Fax:347-919-5546
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INA5011322A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist