Healthcare Provider Details

I. General information

NPI: 1780594549
Provider Name (Legal Business Name): CHIDIMMA UWAOMAH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 NW 17TH ST
DORAL FL
33126-1025
US

IV. Provider business mailing address

2930 SW 69TH CT APT 4311
MIAMI FL
33155-2872
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-5542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: