Provider Demographics
NPI:1013498427
Name:OSIFOH, LAURA UGOCHI (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:UGOCHI
Last Name:OSIFOH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 FLAGSTONE
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8171
Mailing Address - Country:US
Mailing Address - Phone:214-934-7171
Mailing Address - Fax:
Practice Address - Street 1:2700 WALKER WAY
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2088
Practice Address - Country:US
Practice Address - Phone:972-298-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty