Healthcare Provider Details

I. General information

NPI: 1184014201
Provider Name (Legal Business Name): DIMMA OKOLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 DRY BANK LN
PEARLAND TX
77584-2517
US

IV. Provider business mailing address

2513 DRY BANK LN
PEARLAND TX
77584-2517
US

V. Phone/Fax

Practice location:
  • Phone: 832-704-0499
  • Fax:
Mailing address:
  • Phone: 832-704-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1232426
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: