Healthcare Provider Details

I. General information

NPI: 1043869563
Provider Name (Legal Business Name): NATHANIEL TOYIN OWOADE PT FOR HAPPY DAVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WARREN RD STE 250
COCKEYSVILLE MD
21030-2500
US

IV. Provider business mailing address

10 WARREN RD STE 250
COCKEYSVILLE MD
21030-2500
US

V. Phone/Fax

Practice location:
  • Phone: 410-683-0572
  • Fax:
Mailing address:
  • Phone: 410-683-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25425
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: