Provider Demographics
NPI:1992045751
Name:OGBONNAYA, KELECHI (DPT)
Entity Type:Individual
Prefix:
First Name:KELECHI
Middle Name:
Last Name:OGBONNAYA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 N JOHN B DENNIS HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5888
Mailing Address - Country:US
Mailing Address - Phone:423-288-0313
Mailing Address - Fax:423-288-0383
Practice Address - Street 1:2424 N JOHN B DENNIS HWY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5888
Practice Address - Country:US
Practice Address - Phone:423-288-0313
Practice Address - Fax:423-288-0383
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist