Provider Demographics
NPI:1841969631
Name:NDUKA, OLUEBUBE
Entity type:Individual
Prefix:
First Name:OLUEBUBE
Middle Name:
Last Name:NDUKA
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 1:1076 W CHANDLER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5223
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:
Practice Address - Street 1:21083 N JOHN WAYNE PKWY STE C104
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2961
Practice Address - Country:US
Practice Address - Phone:520-233-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty