Healthcare Provider Details

I. General information

NPI: 1003432097
Provider Name (Legal Business Name): TRIUMPH PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MASSACHUSETTS AVE NW # 340
WASHINGTON DC
20016-4358
US

IV. Provider business mailing address

1710 W VIRGINIA AVE NE UNIT 101
WASHINGTON DC
20002-2338
US

V. Phone/Fax

Practice location:
  • Phone: 240-336-4976
  • Fax:
Mailing address:
  • Phone: 202-739-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OMOLOLU OLUWATOSIN MAJEKODUNMI
Title or Position: CEO
Credential: OTR/L
Phone: 240-336-4976