Healthcare Provider Details

I. General information

NPI: 1053039586
Provider Name (Legal Business Name): AYODELE ADEMOLA OGUNGBIRE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N POST OAK RD STE 100
HOUSTON TX
77055-7237
US

IV. Provider business mailing address

8432 BERRY BRUSH LN
HOUSTON TX
77022-1752
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-4868
  • Fax: 713-686-5127
Mailing address:
  • Phone: 817-690-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1367186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: