Provider Demographics
NPI:1538767348
Name:IGWEBUIKE, GRACE CHINENYE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:CHINENYE
Last Name:IGWEBUIKE
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 1:6200 RENWICK DR APT 474
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3850
Mailing Address - Country:US
Mailing Address - Phone:832-417-4792
Mailing Address - Fax:
Practice Address - Street 1:19424 MCKAY DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5706
Practice Address - Country:US
Practice Address - Phone:281-319-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1337410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist