MEDICARE: OLUWATOBI TOLUWA OWOTOMO 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	225100000X	Physical Therapist	6248	OK

General Provider Information

NPI Number	:	1760338552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWATOBI TOLUWA OWOTOMO DPT

Provider Business Mailing Address
First Line	:	1108 W WILSHIRE BLVD
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6107
Country	:	US
Telephone Number	:	347-216-9667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 W WILSHIRE BLVD
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6107
Country	:	US
Telephone Number	:	347-216-9667
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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