Provider Demographics
NPI:1609474410
Name:ANABA, NNABUIKEM NDUBUISI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NNABUIKEM
Middle Name:NDUBUISI
Last Name:ANABA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:IYKE
Other - Middle Name:NDUBUISI
Other - Last Name:ANABA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3591 W 22ND ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7643
Mailing Address - Country:US
Mailing Address - Phone:773-865-1522
Mailing Address - Fax:
Practice Address - Street 1:1150 W 24TH ST STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8368
Practice Address - Country:US
Practice Address - Phone:773-865-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-013210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist