Healthcare Provider Details

I. General information

NPI: 1083551741
Provider Name (Legal Business Name): TREASURE COAST NON-SURGICAL ORTHOPEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 VIRGINIA AVE STE 45
FORT PIERCE FL
34982-5893
US

IV. Provider business mailing address

10380 SW VILLAGE CENTER DR STE 148
PORT ST LUCIE FL
34987-1931
US

V. Phone/Fax

Practice location:
  • Phone: 772-266-7846
  • Fax: 561-510-9738
Mailing address:
  • Phone: 772-266-7846
  • Fax: 561-510-9738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUDARE OGUNSOLA
Title or Position: PHYSICIAN OWNER AND CEO
Credential: DO
Phone: 772-266-7846