Provider Demographics
NPI:1174356638
Name:OGBATA, CHISOM VIVIAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHISOM
Middle Name:VIVIAN
Last Name:OGBATA
Suffix:
Gender:F
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 1:6711 SAN PABLO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2119
Mailing Address - Country:US
Mailing Address - Phone:832-497-7153
Mailing Address - Fax:
Practice Address - Street 1:6200 N BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7536
Practice Address - Country:US
Practice Address - Phone:713-778-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1398703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist