Healthcare Provider Details

I. General information

NPI: 1114584810
Provider Name (Legal Business Name): OLUWASEYI OGUNYE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 FORT WASHINGTON RD
FORT WASHINGTON MD
20744-5843
US

IV. Provider business mailing address

7218 MAHOGANY DR
LANDOVER MD
20785-5821
US

V. Phone/Fax

Practice location:
  • Phone: 301-292-5100
  • Fax: 301-292-2847
Mailing address:
  • Phone: 714-616-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27442
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: