Healthcare Provider Details

I. General information

NPI: 1780450106
Provider Name (Legal Business Name): INIOLUWA HAVILAH OGUNSEMOWO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BUSINESS CENTER DR STE 100
HORSHAM PA
19044-3434
US

IV. Provider business mailing address

1151 E HECTOR ST APT 208
CONSHOHOCKEN PA
19428-0018
US

V. Phone/Fax

Practice location:
  • Phone: 215-293-8882
  • Fax:
Mailing address:
  • Phone: 240-753-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: