Provider Demographics
NPI:1992365050
Name:OFOR, IKEDICHI C (PT, DPT, FAFS)
Entity Type:Individual
Prefix:
First Name:IKEDICHI
Middle Name:C
Last Name:OFOR
Suffix:
Gender:M
Credentials:PT, DPT, FAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 RICE ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5216
Mailing Address - Country:US
Mailing Address - Phone:305-792-8393
Mailing Address - Fax:305-444-1523
Practice Address - Street 1:200 S BISCAYNE BLVD STE 15A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2368
Practice Address - Country:US
Practice Address - Phone:305-381-6224
Practice Address - Fax:305-381-6294
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist