Provider Demographics
NPI:1639755648
Name:OZOIGBO, UCHECHUKWU PHILIP (PT)
Entity Type:Individual
Prefix:
First Name:UCHECHUKWU
Middle Name:PHILIP
Last Name:OZOIGBO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18149 66TH CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4106
Mailing Address - Country:US
Mailing Address - Phone:708-916-7398
Mailing Address - Fax:
Practice Address - Street 1:18149 66TH CT
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4106
Practice Address - Country:US
Practice Address - Phone:708-916-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist