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General NPI Number Information
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NPI Number | 1235546946
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Entity Type | Individual
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Provider Name | OMOLARA TUGBIYELE P.T.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 6896 SUNFLOWER LN
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City | MACUNGIE
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State | PA
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Zip | 18062-8662
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Country | US
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Telephone | 610-391-9798
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Fax | 484-214-0015
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Provider Business Mailing Address
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Address Line | 6896 SUNFLOWER LN
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City | MACUNGIE
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State | PA
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Zip | 18062-8662
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Country | US
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Telephone | 610-391-9798
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Fax | 484-214-0015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT019111
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License Number State | PA
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