Individual
CHINONYEREM CAMILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
180 STATE ST STE 225, SOUTHLAKE, TX 76092-7632
(866) 839-6979
Mailing address
180 STATE ST STE 225, SOUTHLAKE, TX 76092-7632
(866) 839-6979
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1209026
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1069526
TX
Other
Enumeration date
01/12/2022
Last updated
03/20/2026
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