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NPI Code Detail

MEDICARE: CHISOM VIVIAN OGBATA PT, DPT

MEDICARE: CHISOM VIVIAN OGBATA PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1398703TX

General Provider Information

NPI Number : 1174356638
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHISOM VIVIAN OGBATA PT, DPT
Provider Business Mailing Address
First Line : 6711 SAN PABLO DR
Second Line :
City : HOUSTON
State : TX
Zip : 77083-2119
Country : US
Telephone Number : 832-497-7153
Fax Number :
Provider Business Practice Location Address
First Line : 6200 N BRAESWOOD BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77074-7536
Country : US
Telephone Number : 713-778-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2024
Last Update Date : 08/21/2024

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