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General NPI Number Information
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NPI Number | 1811412471
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Entity Type | Individual
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Provider Name | DR. OKON BASSUBONG ANTIA
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Gender | Male
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 08/02/2020
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Provider Practice Location Address
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Address Line | 15415 MUESCHKE RD STE C
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City | CYPRESS
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State | TX
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Zip | 77433-1488
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Country | US
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Telephone | 281-241-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 13100 WORTHAM CENTER DR FL 3
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City | HOUSTON
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State | TX
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Zip | 77065-5625
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Country | US
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Telephone | 281-241-7312
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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 |
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License Number State |
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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 | 1179470
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License Number State | TX
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