Provider Demographics
NPI:1164838074
Name:WADJA, ALLEN (PT)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:WADJA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 VISTA DEL SOL DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6118
Mailing Address - Country:US
Mailing Address - Phone:915-855-8237
Mailing Address - Fax:915-751-1660
Practice Address - Street 1:11920 VISTA DEL SOL DR BLDG B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6118
Practice Address - Country:US
Practice Address - Phone:915-855-8237
Practice Address - Fax:915-751-1660
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist