Provider Demographics
NPI:1396409207
Name:ADEBISI, OLAYIWOLA (PTA)
Entity Type:Individual
Prefix:
First Name:OLAYIWOLA
Middle Name:
Last Name:ADEBISI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 HORSE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7059
Mailing Address - Country:US
Mailing Address - Phone:832-532-0668
Mailing Address - Fax:
Practice Address - Street 1:9777 W GULF BANK RD STE 10
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-3137
Practice Address - Country:US
Practice Address - Phone:713-849-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation