Healthcare Provider Details

I. General information

NPI: 1942779152
Provider Name (Legal Business Name): CHUKWUELOKA ANTHONY UTTI P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 E 71ST ST
CHICAGO IL
60649-2612
US

IV. Provider business mailing address

17307 LATHROP AVE APT 3
EAST HAZEL CREST IL
60429-2605
US

V. Phone/Fax

Practice location:
  • Phone: 773-721-5000
  • Fax:
Mailing address:
  • Phone: 646-270-0158
  • 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: