Provider Demographics
NPI:1558924928
Name:EZEAMURUNAMMA, OBINNA CHIKA
Entity Type:Individual
Prefix:
First Name:OBINNA
Middle Name:CHIKA
Last Name:EZEAMURUNAMMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 TRITONVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-9207
Mailing Address - Country:US
Mailing Address - Phone:919-889-2408
Mailing Address - Fax:
Practice Address - Street 1:3808 TRITONVILLE WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-9207
Practice Address - Country:US
Practice Address - Phone:919-889-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18542225100000X
KYCP000816T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist