Healthcare Provider Details

I. General information

NPI: 1376055129
Provider Name (Legal Business Name): MICHAEL OJIABO UKOHA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 SEVEN LOCKS RD
POTOMAC MD
20854-3260
US

IV. Provider business mailing address

5720 FISHERS LN APT 316
ROCKVILLE MD
20852-1891
US

V. Phone/Fax

Practice location:
  • Phone: 301-880-7955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: