Provider Demographics
NPI:1255149126
Name:CHIMA, ANTHONY CHIEDU JR (LMT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CHIEDU
Last Name:CHIMA
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LEE ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASAW
Mailing Address - State:AL
Mailing Address - Zip Code:36611-2107
Mailing Address - Country:US
Mailing Address - Phone:251-767-4286
Mailing Address - Fax:
Practice Address - Street 1:211 LEE ST
Practice Address - Street 2:
Practice Address - City:CHICKASAW
Practice Address - State:AL
Practice Address - Zip Code:36611-2107
Practice Address - Country:US
Practice Address - Phone:251-767-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist