Individual
JAMES HARDEY DIMAILIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009135A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000504588
ANTHEM - MBWOUDE
IN
01
—
000000504592
ANTHEM - 1ST AID PLUS
IN
01
—
000000504597
ANTHEM - APT PLUS
IN
Enumeration date
11/17/2006
Last updated
02/06/2020
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