Healthcare Provider Details

I. General information

NPI: 1063988392
Provider Name (Legal Business Name): CHUKWUGOZI OBUAYA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 10/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 WESTERBROOK LN
HUMBLE TX
77396-4141
US

IV. Provider business mailing address

8507 WESTERBROOK LN
HUMBLE TX
77396-4141
US

V. Phone/Fax

Practice location:
  • Phone: 832-627-3499
  • Fax:
Mailing address:
  • Phone: 832-627-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1198001
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: