Basic Information
| Provider Information | |||||||||
| NPI: | 1871217257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELIPE | ||||||||
| FirstName: | EMMANUEL | ||||||||
| MiddleName: | CAMINO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13921 WASHITA CT | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460338550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176455249 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5045 W 52ND ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462541705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172932929 | ||||||||
| FaxNumber: | 3174495783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2022 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.