Provider Demographics
NPI:1063587301
Name:BIOKORO, GODWIN O (PT)
Entity type:Individual
Prefix:DR
First Name:GODWIN
Middle Name:O
Last Name:BIOKORO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 E MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:TRAIL CREEK
Mailing Address - State:IN
Mailing Address - Zip Code:46360-6522
Mailing Address - Country:US
Mailing Address - Phone:219-221-6331
Mailing Address - Fax:219-221-6694
Practice Address - Street 1:3025 E MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:TRAIL CREEK
Practice Address - State:IN
Practice Address - Zip Code:46360-6522
Practice Address - Country:US
Practice Address - Phone:219-221-6331
Practice Address - Fax:219-221-6694
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005175A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200673860OtherFIRST STEPS PROGRAM