Healthcare Provider Details

I. General information

NPI: 1427885623
Provider Name (Legal Business Name): HARRISON OGBEWE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 W BURR BLVD STE 5-6
KEARNEYSVILLE WV
25430-4787
US

IV. Provider business mailing address

151 DAVID CT
KEARNEYSVILLE WV
25430-2730
US

V. Phone/Fax

Practice location:
  • Phone: 304-900-0866
  • Fax:
Mailing address:
  • Phone: 508-718-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001933
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004810
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: