Provider Demographics
NPI:1073945655
Name:NWANKPA, IJEOMA EMEKA (PT, DPT, WCS, CLT)
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:EMEKA
Last Name:NWANKPA
Suffix:
Gender:F
Credentials:PT, DPT, WCS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 HOPSON RD APT 1103
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8316
Mailing Address - Country:US
Mailing Address - Phone:678-524-5520
Mailing Address - Fax:
Practice Address - Street 1:6401 ELDORADO PKWY STE 337
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6520
Practice Address - Country:US
Practice Address - Phone:817-381-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011074225100000X
NC15026225100000X
TX1337252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist