Provider Demographics
NPI:1801581434
Name:NWAMUO, ENYINNAYA (PTA)
Entity type:Individual
Prefix:
First Name:ENYINNAYA
Middle Name:
Last Name:NWAMUO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23045 PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3651
Mailing Address - Country:US
Mailing Address - Phone:248-667-2679
Mailing Address - Fax:
Practice Address - Street 1:1207 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2475
Practice Address - Country:US
Practice Address - Phone:325-648-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166781225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant