MEDICARE: OLUREMI WANJIRU ONIFADE 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	PT011155	GA

General Provider Information

NPI Number	:	1821421421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUREMI WANJIRU ONIFADE DPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-350-2644
Fax Number	:	586-541-3735

Provider Business Practice Location Address
First Line	:	1000 WHITE ST SW STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-2634
Country	:	US
Telephone Number	:	470-905-2800
Fax Number	:	470-905-2801

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

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	04/02/2024

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