MEDICARE: TOLULOPE AGBAJE 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	40QA02385600	NJ

General Provider Information

NPI Number	:	1841152311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOLULOPE AGBAJE DPT

Provider Business Mailing Address
First Line	:	PO BOX 1204
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-7204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 BAINBRIDGE DR STE 560
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2816
Country	:	US
Telephone Number	:	972-572-3001
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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