Provider Demographics
NPI:1255899175
Name:UGWU, ONYEDIKACHI
Entity type:Individual
Prefix:
First Name:ONYEDIKACHI
Middle Name:
Last Name:UGWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-5335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 N LOOP 340
Practice Address - Street 2:
Practice Address - City:LACY LAKEVIEW
Practice Address - State:TX
Practice Address - Zip Code:76705-2400
Practice Address - Country:US
Practice Address - Phone:682-802-9986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1312773OtherTEXAS BOARD OF PT LICENSE