Healthcare Provider Details

I. General information

NPI: 1700360781
Provider Name (Legal Business Name): OLUWADAMILOLA T ADEYEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11219 POTRANCO RD STE 110
SAN ANTONIO TX
78253-5849
US

IV. Provider business mailing address

11219 POTRANCO RD STE 110
SAN ANTONIO TX
78253-5849
US

V. Phone/Fax

Practice location:
  • Phone: 210-892-0359
  • Fax: 210-679-6904
Mailing address:
  • Phone: 210-892-0359
  • Fax: 210-679-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1310291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: