Provider Demographics
NPI:1588792949
Name:OLUBOWALE-OSHODI, OLAYINKA ABIMBOLA (PT)
Entity type:Individual
Prefix:MRS
First Name:OLAYINKA
Middle Name:ABIMBOLA
Last Name:OLUBOWALE-OSHODI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 DECLARATION DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6723
Mailing Address - Country:US
Mailing Address - Phone:407-288-2240
Mailing Address - Fax:407-932-3887
Practice Address - Street 1:4525 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6723
Practice Address - Country:US
Practice Address - Phone:407-288-2240
Practice Address - Fax:407-932-3887
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 15946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6492Medicare ID - Type UnspecifiedPART B PROVIDER #