Provider Demographics
NPI:1144819954
Name:EDEGBE, EGHOSASERE HILDA (PT)
Entity type:Individual
Prefix:MS
First Name:EGHOSASERE
Middle Name:HILDA
Last Name:EDEGBE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 W PARMER LN APT 8327
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-4955
Mailing Address - Country:US
Mailing Address - Phone:512-662-7498
Mailing Address - Fax:
Practice Address - Street 1:8701 W PARMER LN APT 8327
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-4955
Practice Address - Country:US
Practice Address - Phone:512-662-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1325654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist