Healthcare Provider Details

I. General information

NPI: 1326634486
Provider Name (Legal Business Name): DIANNA OYEWUNMI OLOJO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6564 LOISDALE CT STE 500
SPRINGFIELD VA
22150-1823
US

IV. Provider business mailing address

PO BOX 1769
MIDDLEBURG VA
20118-1769
US

V. Phone/Fax

Practice location:
  • Phone: 703-822-0039
  • Fax: 703-822-0211
Mailing address:
  • Phone: 703-822-0039
  • Fax: 703-822-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28194
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP-CP010157T
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28194
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP014721T
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: