Provider Demographics
NPI:1902042617
Name:ANYIM, OBIMEFULA OZOEMENAM (PT)
Entity Type:Individual
Prefix:MR
First Name:OBIMEFULA
Middle Name:OZOEMENAM
Last Name:ANYIM
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 1:1690 HEATHER TRACE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7380
Mailing Address - Country:US
Mailing Address - Phone:336-414-5501
Mailing Address - Fax:
Practice Address - Street 1:1690 HEATHER TRACE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7380
Practice Address - Country:US
Practice Address - Phone:336-414-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist