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General NPI Number Information
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NPI Number | 1083340509
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Entity Type | Individual
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Provider Name | GABRIEL EZECHUKWU NDUKWU PT
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Gender | Male
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 4500 13TH ST STE 900
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City | GULFPORT
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State | MS
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Zip | 39501-2515
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Country | US
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Telephone | 228-822-6956
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Fax |
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Provider Business Mailing Address
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Address Line | 203 N CLEVELAND AVE APT 43
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City | LONG BEACH
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State | MS
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Zip | 39560-4727
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Country | US
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Telephone | 228-365-8476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 040194
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT7279
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License Number State | MS
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