Provider Demographics
NPI:1972572048
Name:NWOSU, ANSELM NDUBUISI (PT)
Entity Type:Individual
Prefix:
First Name:ANSELM
Middle Name:NDUBUISI
Last Name:NWOSU
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 1:13352 BECKWITH DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8142
Mailing Address - Country:US
Mailing Address - Phone:317-529-6955
Mailing Address - Fax:317-873-2123
Practice Address - Street 1:13352 BECKWITH DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8142
Practice Address - Country:US
Practice Address - Phone:317-529-6955
Practice Address - Fax:317-873-2123
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004706A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist