Healthcare Provider Details

I. General information

NPI: 1952946824
Provider Name (Legal Business Name): AMARACHI ANGELINA NNAMDI-EZE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMARACHI ANGELINA EJIOGU

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2180
US

IV. Provider business mailing address

5861 ROWANBERRY DR
ELKRIDGE MD
21075-5241
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7100
  • Fax:
Mailing address:
  • Phone: 301-851-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: