MEDICARE: OLUWATITOYIN OGUNSOLA-SMITH PT, DPT, AT

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

General Provider Information

NPI Number	:	1356774921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWATITOYIN OGUNSOLA-SMITH PT, DPT, AT

Provider Business Mailing Address
First Line	:	4315 W SANTIAGO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7723
Country	:	US
Telephone Number	:	813-453-9896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 W SANTIAGO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7723
Country	:	US
Telephone Number	:	813-453-9896
Fax Number	:

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

Provider Enumeration Date	:	08/18/2013
Last Update Date	:	02/26/2019

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