Healthcare Provider Details

I. General information

NPI: 1578321030
Provider Name (Legal Business Name): JOSHUA AMECHI OKONYE PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 WILCREST DR
HOUSTON TX
77042-6718
US

IV. Provider business mailing address

2020 WESTCREEK LN APT 2312
HOUSTON TX
77027-3643
US

V. Phone/Fax

Practice location:
  • Phone: 832-518-0579
  • Fax:
Mailing address:
  • Phone: 832-518-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40745
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1381567
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: