Individual
BOAZ NYONGESA BARASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17475 DUGDALE DR, SOUTH BEND, IN 46635-1545
(574) 247-7500
Mailing address
828 LIBERTY ST, ELKHART, IN 46514-2604
(574) 575-8824
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005605A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
N/A
IN
Enumeration date
01/08/2020
Last updated
01/08/2020
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