Boaz Nyongesa Barasa
Individual provider Active NPI Physical Therapy Assistant · South Bend, IN
NPI 1427698307 · NPPES record last updated Jan 8, 2020
Key facts
- NPI
- 1427698307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 06005605A (IN)
- Practice address
- 17475 Dugdale Dr
South Bend, IN 46635-1545 - Phone
- (574) 247-7500
- NPI assigned
- Jan 8, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06005605A | IN | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 06005605A | IN | Yes |
Addresses
Primary practice location
17475 Dugdale Dr
South Bend, IN 46635-1545
Mailing address
828 Liberty St
Elkhart, IN 46514-2604
Phone (574) 575-8824
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0 | Other | IN | N/A |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Elkhart | Other |
Other providers in South Bend, IN
- Mark Willam Bantz
- Larry William Banyash
- Haidong Bao
- Jillian Renee Baranowski
- Gloria Jean Barany
- Barbara Finley, LCSW/M.Div,. LLC
- Barbara L Williams MD
- Amber Barber
- Thomas P Barbour
- Carolyn M Barbus
All providers in South Bend, IN · Physical Therapy Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.