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General NPI Number Information
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NPI Number | 1790863728
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Entity Type | Individual
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Provider Name | MICHELLE MARIE OKUNYADE M.S.P.T
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1777 N DIXIE HWY
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City | FT LAUDERDALE
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State | FL
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Zip | 33305-3103
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Country | US
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Telephone | 954-980-1485
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Fax |
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Provider Business Mailing Address
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Address Line | 3406 SPRUCE RD
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8420
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Country | US
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Telephone | 954-322-0406
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15253
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License Number State | FL
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