Healthcare Provider Details

I. General information

NPI: 1013392893
Provider Name (Legal Business Name): CHIOMA OLONADE P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 YORK DR STE 104
DESOTO TX
75115-2052
US

IV. Provider business mailing address

951 YORK DR STE 104
DESOTO TX
75115-2052
US

V. Phone/Fax

Practice location:
  • Phone: 214-455-1899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1172428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: