Provider Demographics
NPI:1275833295
Name:OGUNSANYA, OLUGBENGA A (DPT)
Entity Type:Individual
Prefix:
First Name:OLUGBENGA
Middle Name:A
Last Name:OGUNSANYA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 LAKE TER
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6546
Mailing Address - Country:US
Mailing Address - Phone:678-793-7887
Mailing Address - Fax:
Practice Address - Street 1:9050 PERIDOT PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9417
Practice Address - Country:US
Practice Address - Phone:770-474-0540
Practice Address - Fax:770-507-0506
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist