Individual
DR. CHARLES AGBONGHAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4800 MEMORIAL DR, WACO, TX 76711-1329
(254) 421-9364
Mailing address
10021 BIRCH TREE DR, TEMPLE, TX 76502-5368
(254) 421-9364
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1203007
TX
Other
Enumeration date
04/30/2019
Last updated
04/30/2019
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