Provider Demographics
NPI:1528341567
Name:MALIK, NIKHIL (PT, CEAS)
Entity type:Individual
Prefix:
First Name:NIKHIL
Middle Name:
Last Name:MALIK
Suffix:
Gender:M
Credentials:PT, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9768
Mailing Address - Country:US
Mailing Address - Phone:219-616-6475
Mailing Address - Fax:
Practice Address - Street 1:9430 WICKER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9768
Practice Address - Country:US
Practice Address - Phone:219-616-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008631A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist