Damilola Soetan, PT, DPT, AIB-PCON

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

3777 N Frontage Rd Ste 100
Michigan City, IN 46360-7696

Phone

(219) 872-2933

NPI assigned

May 6, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1265097273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 CHICKADEE DR",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463607792",
            "telephone_number": "346-270-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3777 N FRONTAGE RD STE 100",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463607696",
            "telephone_number": "219-872-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOETAN",
        "first_name": "DAMILOLA",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, AIB-PCON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-06",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Michigan City, IN
• Providers in Michigan City, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.