Provider Demographics
NPI:1407184971
Name:OLUFOWOSHE, RITA S (MMP)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:S
Last Name:OLUFOWOSHE
Suffix:
Gender:F
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 SUNDOWN CANYON CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2488
Mailing Address - Country:US
Mailing Address - Phone:281-496-3772
Mailing Address - Fax:
Practice Address - Street 1:950 THREADNEEDLE ST STE 145
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2910
Practice Address - Country:US
Practice Address - Phone:281-496-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-21
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT104006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT104006OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES