MEDICARE: EGASHIA N OLOTU DPT

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	3130624	TX

General Provider Information

NPI Number	:	1588355440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EGASHIA N OLOTU DPT

Provider Business Mailing Address
First Line	:	12660 STAFFORD RD APT 217
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-3542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4899 HIGHWAY 6 STE CAND213C
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3987
Country	:	US
Telephone Number	:	346-371-2121
Fax Number	:

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

Provider Enumeration Date	:	05/19/2023
Last Update Date	:	05/19/2023

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