Healthcare Provider Details

I. General information

NPI: 1760004352
Provider Name (Legal Business Name): ANETOCHUKWU CHETUYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5769 BELT LINE RD
DALLAS TX
75254-7674
US

IV. Provider business mailing address

5769 BELT LINE RD
DALLAS TX
75254-7674
US

V. Phone/Fax

Practice location:
  • Phone: 214-881-6692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: