Individual
FATAI BOLAJI ADISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
8691 CONNECTICUT ST, STE C, MERRILLVILLE, IN 46410-5541
(219) 525-4176
(219) 472-0841
Mailing address
PO BOX 10644, MERRILLVILLE, IN 46411-0644
(219) 525-4176
(219) 750-9451
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05005905A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201269820A
—
IN
Enumeration date
05/18/2006
Last updated
11/20/2019
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