Provider Demographics
NPI:1689952442
Name:OGBODO, NKECHI (PT)
Entity Type:Individual
Prefix:
First Name:NKECHI
Middle Name:
Last Name:OGBODO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:OGBODO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:7517 W COLDSPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2814
Mailing Address - Country:US
Mailing Address - Phone:414-327-6603
Mailing Address - Fax:414-327-5411
Practice Address - Street 1:7517 W COLDSPRING RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-2814
Practice Address - Country:US
Practice Address - Phone:414-327-6603
Practice Address - Fax:414-327-5411
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9762-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist