Provider Demographics
NPI:1194176933
Name:OGUNYEMI, OLUFEMI
Entity type:Individual
Prefix:
First Name:OLUFEMI
Middle Name:
Last Name:OGUNYEMI
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 1:236 BRICKNELL LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2597
Mailing Address - Country:US
Mailing Address - Phone:214-223-4753
Mailing Address - Fax:
Practice Address - Street 1:2620 COMMUNICATIONS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8800
Practice Address - Country:US
Practice Address - Phone:214-501-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2082691225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant