Provider Demographics
NPI:1225861099
Name:OBI-ANADIUME, MICHAEL EZEKWESILI (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EZEKWESILI
Last Name:OBI-ANADIUME
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 1:21122 LAKE TALIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3737
Mailing Address - Country:US
Mailing Address - Phone:813-527-1355
Mailing Address - Fax:
Practice Address - Street 1:21122 LAKE TALIA BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3737
Practice Address - Country:US
Practice Address - Phone:813-527-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist