Provider Demographics
NPI:1780911792
Name:AKALUSO, UCHENNA C
Entity type:Individual
Prefix:
First Name:UCHENNA
Middle Name:C
Last Name:AKALUSO
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 1:7211 REGENCY SQUARE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3137
Mailing Address - Country:US
Mailing Address - Phone:713-244-9505
Mailing Address - Fax:888-336-7050
Practice Address - Street 1:7211 REGENCY SQUARE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3137
Practice Address - Country:US
Practice Address - Phone:713-244-9505
Practice Address - Fax:888-336-7050
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677999163WH0200X
TX2119910225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1817165-01Medicaid
TX1817165-01Medicaid