Provider Demographics
NPI:1437256971
Name:EDOZIE, CALLISTUS CHIMEZIE
Entity type:Individual
Prefix:MR
First Name:CALLISTUS
Middle Name:CHIMEZIE
Last Name:EDOZIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 COMMERCE PARK
Mailing Address - Street 2:SUITE 249
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-272-8699
Mailing Address - Fax:713-541-5699
Practice Address - Street 1:8700 COMMERCE PARK
Practice Address - Street 2:SUITE 249
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-272-8699
Practice Address - Fax:713-541-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist