Healthcare Provider Details

I. General information

NPI: 1356774921
Provider Name (Legal Business Name): OLUWATITOYIN OGUNSOLA-SMITH PT, DPT, AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TITO OGUNSOLA-SMITH

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 W SANTIAGO ST
TAMPA FL
33629-7723
US

IV. Provider business mailing address

4315 W SANTIAGO ST
TAMPA FL
33629-7723
US

V. Phone/Fax

Practice location:
  • Phone: 813-453-9896
  • Fax:
Mailing address:
  • Phone: 813-453-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: