Provider Demographics
NPI:1932586757
Name:AJISAFE, MARY JOY ENAIHO (PT,DPT)
Entity Type:Individual
Prefix:
First Name:MARY JOY
Middle Name:ENAIHO
Last Name:AJISAFE
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:MARY JOY
Other - Middle Name:ENAIHO
Other - Last Name:AJISAFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:10200 SIX PINES DR APT 249
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2587
Mailing Address - Country:US
Mailing Address - Phone:469-767-0490
Mailing Address - Fax:
Practice Address - Street 1:10200 SIX PINES DR APT 249
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-2587
Practice Address - Country:US
Practice Address - Phone:469-767-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1248282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist