MEDICARE: CARRIE OLAGBAIYE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251N0400X	Neurology Physical Therapist	9484	MN

General Provider Information

NPI Number	:	1104790583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE OLAGBAIYE DPT

Provider Business Mailing Address
First Line	:	4615 LENORE LN
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 UNIVERSITY AVE W STE 140
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1844
Country	:	US
Telephone Number	:	612-273-6228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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