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Individual

AUSTIN NOSAKHARE OMWANGHE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, DPT

Contact information

Practice address
6294 HIDDEN BROOK PL, ETIWANDA, CA 91739-9427
(909) 297-0840
Mailing address
6294 HIDDEN BROOK PL, ETIWANDA, CA 91739-9427
(909) 297-0840

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT013536
GA
225100000X
Physical Therapist
Primary
PT297773
CA

Other

Enumeration date
08/30/2018
Last updated
02/05/2021
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