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General NPI Number Information
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NPI Number | 1992365050
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Entity Type | Individual
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Provider Name | IKEDICHI C OFOR PT, DPT, FAFS
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Gender | Male
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 200 S BISCAYNE BLVD STE 15A
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City | MIAMI
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State | FL
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Zip | 33131-2368
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Country | US
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Telephone | 305-381-6224
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Fax | 305-381-6294
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Provider Business Mailing Address
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Address Line | 3305 RICE ST
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City | MIAMI
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State | FL
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Zip | 33133-5216
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Country | US
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Telephone | 305-792-8393
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Fax | 305-444-1523
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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 | 070024381
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License Number State | IL
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