Healthcare Provider Details

I. General information

NPI: 1124947064
Provider Name (Legal Business Name): EZINNE VIVIAN OKORO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 HEDGE LANE TER
SHAWNEE KS
66227-3017
US

IV. Provider business mailing address

7740 HEDGE LANE TER
SHAWNEE KS
66227-3017
US

V. Phone/Fax

Practice location:
  • Phone: 913-745-7537
  • Fax: 844-273-2719
Mailing address:
  • Phone: 913-745-7537
  • Fax: 844-273-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-08178
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: