Provider Demographics
NPI:1144606401
Name:OLOWE, OMOLADE TAIYE (PT)
Entity Type:Individual
Prefix:
First Name:OMOLADE
Middle Name:TAIYE
Last Name:OLOWE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WALNUT HILL ST APT 7D
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1541
Mailing Address - Country:US
Mailing Address - Phone:850-225-1987
Mailing Address - Fax:
Practice Address - Street 1:2801 WALNUT HILL ST APT 7D
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1541
Practice Address - Country:US
Practice Address - Phone:850-225-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026645225100000X
AZ115192251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics