Provider Demographics
NPI:1831623396
Name:TEDUNJAIYE, EGHOSA (DPT)
Entity type:Individual
Prefix:
First Name:EGHOSA
Middle Name:
Last Name:TEDUNJAIYE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 COLLEGE LN APT L
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-3139
Mailing Address - Country:US
Mailing Address - Phone:909-809-1698
Mailing Address - Fax:
Practice Address - Street 1:801 COLLEGE LN APT L
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-3139
Practice Address - Country:US
Practice Address - Phone:909-809-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist