Healthcare Provider Details

I. General information

NPI: 1841202702
Provider Name (Legal Business Name): MR. OLALEKAN JOSEPH OLOWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 MONTANA AVE
EL PASO TX
79925-1221
US

IV. Provider business mailing address

8700 MONTANA AVE
EL PASO TX
79925-1221
US

V. Phone/Fax

Practice location:
  • Phone: 915-771-8523
  • Fax: 915-771-8046
Mailing address:
  • Phone: 915-771-8523
  • Fax: 915-771-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1086973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: