Basic Information
| Provider Information | |||||||||
| NPI: | 1902419757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UKAEGBU | ||||||||
| FirstName: | CHINYERE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4058 | ||||||||
| Address2: | |||||||||
| City: | CROFTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211144058 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 WHITE MARSH PARK DR | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207154361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012625852 | ||||||||
| FaxNumber: | 3012623173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2020 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT872755 | DC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 28595 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.