Healthcare Provider Details

I. General information

NPI: 1437704897
Provider Name (Legal Business Name): ADAEZE OKORO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

IV. Provider business mailing address

701 PARKVIEW DR
ROUND ROCK TX
78681-5744
US

V. Phone/Fax

Practice location:
  • Phone: 512-797-2336
  • Fax:
Mailing address:
  • Phone: 512-797-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1317492
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: