Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 05007720A | IN |
NPI | 1013168905 |
---|---|
Provider Name | Lloyd Bolivar Limbaga JR. |
First Address | Mishawaka, IN 46545-3455 |
Second Address | Mishawaka, IN 46545-3455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2008 |
Last Update Date | 09/10/2008 |