Healthcare Provider Details

I. General information

NPI: 1083340509
Provider Name (Legal Business Name): GABRIEL EZECHUKWU NDUKWU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 LONG IRON DR APT 807
ROCKLEDGE FL
32955-6602
US

IV. Provider business mailing address

1841 LONG IRON DR APT 807
ROCKLEDGE FL
32955-6602
US

V. Phone/Fax

Practice location:
  • Phone: 228-365-8476
  • Fax:
Mailing address:
  • Phone: 228-365-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7279
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040194
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT44171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: