Provider Demographics
NPI:1497881924
Name:EGBEBIKE, JOSEPH KIZITO (PHD,PT)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KIZITO
Last Name:EGBEBIKE
Suffix:
Gender:M
Credentials:PHD,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 UNIVERSITY BLVD N # 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2422
Mailing Address - Country:US
Mailing Address - Phone:904-803-1193
Mailing Address - Fax:904-743-1668
Practice Address - Street 1:3536 UNIVERSITY BLVD N # 110
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2422
Practice Address - Country:US
Practice Address - Phone:904-803-1193
Practice Address - Fax:904-743-1668
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist