Provider Demographics
NPI:1386261188
Name:CHUKWUMA, UDOKA
Entity type:Individual
Prefix:
First Name:UDOKA
Middle Name:
Last Name:CHUKWUMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23831 STATELY OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-3513
Mailing Address - Country:US
Mailing Address - Phone:469-733-7089
Mailing Address - Fax:
Practice Address - Street 1:23831 STATELY OAKS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-3513
Practice Address - Country:US
Practice Address - Phone:469-733-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1187660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist