Provider Demographics
NPI:1821286030
Name:KANKHWENDE, CHIKUMBUTSO ELLEN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:CHIKUMBUTSO
Middle Name:ELLEN
Last Name:KANKHWENDE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 SOFTWOOD TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2200
Mailing Address - Country:US
Mailing Address - Phone:240-342-2312
Mailing Address - Fax:
Practice Address - Street 1:3504 SOFTWOOD TER
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2200
Practice Address - Country:US
Practice Address - Phone:240-342-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA31312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics