MEDICARE: OLAYINKA GBENGA FOLAYAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT870759	DC

General Provider Information

NPI Number	:	1003953183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLAYINKA GBENGA FOLAYAN PT

Provider Business Mailing Address
First Line	:	3410 MANDERES PLACE
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774
Country	:	US
Telephone Number	:	240-899-2251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 MANDERES PL
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774-2526
Country	:	US
Telephone Number	:	240-899-2251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/24/2017

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