Provider Demographics
NPI:1033664180
Name:OLOMOJOBI, OLUWASEGUN (PT)
Entity Type:Individual
Prefix:
First Name:OLUWASEGUN
Middle Name:
Last Name:OLOMOJOBI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700688
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0688
Mailing Address - Country:US
Mailing Address - Phone:210-318-3007
Mailing Address - Fax:210-468-0682
Practice Address - Street 1:111 TOWER DR BLDG 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3625
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1278082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP022980TOtherPHYSICAL THERAPIST LICENSE
TX1278082OtherPHYSICAL THERAPIST LICENSE
VACP022446TOtherPHYSICAL THERAPIST LICENSE
OHCP022979TOtherPHYSICAL THERAPIST LICENSE