Provider Demographics
NPI:1912076910
Name:SEGOSEBE, ANNAH (PT)
Entity type:Individual
Prefix:
First Name:ANNAH
Middle Name:
Last Name:SEGOSEBE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12711 ALYSSA AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3951
Mailing Address - Country:US
Mailing Address - Phone:281-650-8919
Mailing Address - Fax:281-815-2949
Practice Address - Street 1:12711 ALYSSA AVE
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3951
Practice Address - Country:US
Practice Address - Phone:281-650-8919
Practice Address - Fax:281-815-2949
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10664962251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics