Provider Demographics
NPI:1285091777
Name:OKUNROBO, BRIGHT OSARETIN (DPT)
Entity type:Individual
Prefix:DR
First Name:BRIGHT
Middle Name:OSARETIN
Last Name:OKUNROBO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:881 FAIRMOUNT PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4256
Mailing Address - Country:US
Mailing Address - Phone:917-774-7657
Mailing Address - Fax:718-617-4052
Practice Address - Street 1:881 FAIRMOUNT PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4256
Practice Address - Country:US
Practice Address - Phone:917-774-7657
Practice Address - Fax:718-617-4052
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist