Provider Demographics
NPI:1104524578
Name:KOMBO, DEXTER TAKURA (PT, DPT)
Entity type:Individual
Prefix:
First Name:DEXTER
Middle Name:TAKURA
Last Name:KOMBO
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 1:9119 HWY 6 STE 230
Mailing Address - Street 2:#71
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1067
Mailing Address - Country:US
Mailing Address - Phone:409-223-3151
Mailing Address - Fax:
Practice Address - Street 1:1828 E FLORENCE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4783
Practice Address - Country:US
Practice Address - Phone:520-510-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1374030225100000X
AZCP033305T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist