MEDICARE: DAMITA R OLORUNFEMI PTA

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1164551149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMITA R OLORUNFEMI PTA

Provider Business Mailing Address
First Line	:	7380 SW 60TH AVE
Second Line	:	SUITE3
City	:	OCALA
State	:	FL
Zip	:	34476-6407
Country	:	US
Telephone Number	:	352-840-0004
Fax Number	:	352-873-2631

Provider Business Practice Location Address
First Line	:	7380 SW 60TH AVE
Second Line	:	SUITE 3
City	:	OCALA
State	:	FL
Zip	:	34476-6407
Country	:	US
Telephone Number	:	352-840-0004
Fax Number	:	352-873-2631

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/06/2012

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