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NPI Code Detail

MEDICARE: AUGUSTINA OGUNTOLA PT, DPT

MEDICARE: AUGUSTINA OGUNTOLA PT, 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
1225100000XPhysical Therapist29082FL
2225100000XPhysical Therapist2305208518VA

General Provider Information

NPI Number : 1891107256
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUGUSTINA OGUNTOLA PT, DPT
Provider Business Mailing Address
First Line : 1351 DORADO DR APT B
Second Line :
City : KISSIMMEE
State : FL
Zip : 34741-7901
Country : US
Telephone Number : 407-791-4009
Fax Number :
Provider Business Practice Location Address
First Line : 14055 TOWN LOOP BLVD STE 300
Second Line :
City : ORLANDO
State : FL
Zip : 32837-6106
Country : US
Telephone Number : 407-857-6285
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2014
Last Update Date : 05/21/2014

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