Provider Demographics
NPI:1063994655
Name:OMWANGHE, AUSTIN NOSAKHARE (PT, DPT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:NOSAKHARE
Last Name:OMWANGHE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6294 HIDDEN BROOK PL
Mailing Address - Street 2:
Mailing Address - City:ETIWANDA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9427
Mailing Address - Country:US
Mailing Address - Phone:909-297-0840
Mailing Address - Fax:
Practice Address - Street 1:6294 HIDDEN BROOK PL
Practice Address - Street 2:
Practice Address - City:ETIWANDA
Practice Address - State:CA
Practice Address - Zip Code:91739-9427
Practice Address - Country:US
Practice Address - Phone:909-297-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013536225100000X
CAPT297773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist