Provider Demographics
NPI:1881731818
Name:NEWBOLDS, DAVID RAY (MPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAY
Last Name:NEWBOLDS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 VALPARAISO DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2866
Mailing Address - Country:US
Mailing Address - Phone:219-924-3512
Mailing Address - Fax:219-924-4978
Practice Address - Street 1:9711 VALPARAISO DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2866
Practice Address - Country:US
Practice Address - Phone:219-924-3512
Practice Address - Fax:219-924-4978
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003491A225100000X
IL070011800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN199620FMedicare PIN
IN200120GMedicare PIN