Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06003312A | IN |
NPI | 1003068560 |
---|---|
Provider Name | Anne Ajiyi Bamidele |
First Address | Muncie, IN 47304-5947 |
Second Address | Muncie, IN 47303-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2008 |
Last Update Date | 16/10/2008 |