Provider Demographics
NPI:1902536279
Name:OGUNOLA, EBUNOLUWA ABODUNRIN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:EBUNOLUWA
Middle Name:ABODUNRIN
Last Name:OGUNOLA
Suffix:
Gender:
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1540 EASTCHASE PKWY STE 4A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-4404
Practice Address - Country:US
Practice Address - Phone:972-979-6577
Practice Address - Fax:817-672-0938
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist