Provider Demographics
NPI:1073997938
Name:OLUWAFEMI, YANIQUE KAYANA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:YANIQUE
Middle Name:KAYANA
Last Name:OLUWAFEMI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETH SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9109 LIBERTY RD
Practice Address - Street 2:PATAPSCO VALLEY CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21133
Practice Address - Country:US
Practice Address - Phone:410-655-7373
Practice Address - Fax:410-655-0348
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22458OtherPT LICENSE