Healthcare Provider Details

I. General information

NPI: 1851641575
Provider Name (Legal Business Name): UCHENNA UZOMA NDUBISI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 12/02/2025
Certification Date: 11/17/2025
Deactivation Date: 11/17/2025
Reactivation Date: 12/02/2025

III. Provider practice location address

4321 HARTWICK RD SUITE 101
COLLEGE PARK MD
20740-3210
US

IV. Provider business mailing address

5039 TOWNSHIP LINE RD
DREXEL HILL PA
19026-4847
US

V. Phone/Fax

Practice location:
  • Phone: 301-277-6616
  • Fax: 301-277-6618
Mailing address:
  • Phone: 484-521-3660
  • Fax: 484-521-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number24180
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24180
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP049508T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: