Healthcare Provider Details

I. General information

NPI: 1104790583
Provider Name (Legal Business Name): CARRIE OLAGBAIYE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE DENIEL DPT

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 UNIVERSITY AVE W STE 140
SAINT PAUL MN
55114-1844
US

IV. Provider business mailing address

4615 LENORE LN
EAGAN MN
55122-2654
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-6228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number9484
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: