Healthcare Provider Details

I. General information

NPI: 1366717639
Provider Name (Legal Business Name): OLAYINKA IPAYE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 12/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 S CALIFORNIA AVE
CHICAGO IL
60608-5106
US

IV. Provider business mailing address

2829 S CALIFORNIA AVE
CHICAGO IL
60608-5106
US

V. Phone/Fax

Practice location:
  • Phone: 773-376-8320
  • Fax: 773-376-8321
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070018949
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: