Provider Demographics
NPI:1194958819
Name:OYEWOLE, ROTIMI (PT)
Entity type:Individual
Prefix:
First Name:ROTIMI
Middle Name:
Last Name:OYEWOLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 HARVEST BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7543
Mailing Address - Country:US
Mailing Address - Phone:770-682-9840
Mailing Address - Fax:
Practice Address - Street 1:909 HARVEST BROOK DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7543
Practice Address - Country:US
Practice Address - Phone:770-682-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist