Provider Demographics
NPI:1235167974
Name:OLORUNFEMI, RAIFU ADEWALE (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:RAIFU
Middle Name:ADEWALE
Last Name:OLORUNFEMI
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7380 SW 60TH AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6467
Mailing Address - Country:US
Mailing Address - Phone:352-840-0004
Mailing Address - Fax:352-873-2631
Practice Address - Street 1:7380SW 60TH AVE
Practice Address - Street 2:STE 3
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6467
Practice Address - Country:US
Practice Address - Phone:352-840-0004
Practice Address - Fax:352-873-2631
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884834300Medicaid
FL884834300Medicaid