Provider Demographics
NPI:1447818174
Name:CHUKWUDIFU, CHUKWUJINDU FRANCIS (DPT)
Entity type:Individual
Prefix:
First Name:CHUKWUJINDU
Middle Name:FRANCIS
Last Name:CHUKWUDIFU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KEVIN CT
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-9748
Mailing Address - Country:US
Mailing Address - Phone:570-692-1957
Mailing Address - Fax:
Practice Address - Street 1:33 DEAK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1268
Practice Address - Country:US
Practice Address - Phone:570-692-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0004077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A06785389OtherNIGERIAN PASSPORT