Provider Demographics
NPI:1336355940
Name:NWABUEBO, ANIEKAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANIEKAN
Middle Name:
Last Name:NWABUEBO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANIEKAN
Other - Middle Name:
Other - Last Name:UDOFIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18292 ST GEORGES CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-7421
Mailing Address - Country:US
Mailing Address - Phone:703-209-3359
Mailing Address - Fax:
Practice Address - Street 1:301 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2603
Practice Address - Country:US
Practice Address - Phone:650-632-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01220100225100000X
VA2305204026225100000X, 2251X0800X
NY028228-1225100000X
MD21470225100000X
CAPT296532208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic