Provider Demographics
NPI:1851641575
Name:NDUBISI, UCHENNA UZOMA
Entity type:Individual
Prefix:
First Name:UCHENNA
Middle Name:UZOMA
Last Name:NDUBISI
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 1:5039 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4847
Mailing Address - Country:US
Mailing Address - Phone:484-521-3660
Mailing Address - Fax:484-521-3661
Practice Address - Street 1:4321 HARTWICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3210
Practice Address - Country:US
Practice Address - Phone:301-277-6616
Practice Address - Fax:301-277-6618
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2025-12-02
Deactivation Date:2025-11-17
Deactivation Code:
Reactivation Date:2025-12-02
Provider Licenses
StateLicense IDTaxonomies
MD241802251X0800X, 225100000X
PACP049508T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic