Provider Demographics
NPI:1477785061
Name:ITEOGU, BINTA A (DPT)
Entity Type:Individual
Prefix:DR
First Name:BINTA
Middle Name:A
Last Name:ITEOGU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 LEONARDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4618
Mailing Address - Country:US
Mailing Address - Phone:301-592-4777
Mailing Address - Fax:301-588-0843
Practice Address - Street 1:8380 COLESVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6255
Practice Address - Country:US
Practice Address - Phone:301-588-7778
Practice Address - Fax:301-588-0843
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist