Healthcare Provider Details

I. General information

NPI: 1073810040
Provider Name (Legal Business Name): OBIOMA OGBUAWA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST STE B
LEESBURG VA
20176-4171
US

IV. Provider business mailing address

525 E MARKET ST STE B
LEESBURG VA
20176-4171
US

V. Phone/Fax

Practice location:
  • Phone: 703-443-6700
  • Fax:
Mailing address:
  • Phone: 703-443-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: