Provider Demographics
NPI:1235546946
Name:TUGBIYELE, OMOLARA (PT)
Entity Type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:TUGBIYELE
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 1:6896 SUNFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8662
Mailing Address - Country:US
Mailing Address - Phone:610-391-9798
Mailing Address - Fax:484-214-0015
Practice Address - Street 1:6896 SUNFLOWER LN
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8662
Practice Address - Country:US
Practice Address - Phone:610-391-9798
Practice Address - Fax:484-214-0015
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0191112251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics