Provider Demographics
NPI:1235453697
Name:FASANYA, OYENIKE O (PT)
Entity Type:Individual
Prefix:MRS
First Name:OYENIKE
Middle Name:O
Last Name:FASANYA
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 1:2625 ANITA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041
Mailing Address - Country:US
Mailing Address - Phone:972-926-2671
Mailing Address - Fax:972-926-2679
Practice Address - Street 1:2625 ANITA DRIVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041
Practice Address - Country:US
Practice Address - Phone:972-926-2671
Practice Address - Fax:972-926-2679
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11911102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics