Provider Demographics
NPI:1619637774
Name:OMEIKE, VIVIAN NNENNA (PT)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:NNENNA
Last Name:OMEIKE
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 1:997 W AURORA RD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1605
Mailing Address - Country:US
Mailing Address - Phone:877-508-3237
Mailing Address - Fax:
Practice Address - Street 1:3062 EUCLID HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2026
Practice Address - Country:US
Practice Address - Phone:216-233-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist