Provider Demographics
NPI:1407222664
Name:BABALOLA, OLUMIDE A (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:OLUMIDE
Middle Name:A
Last Name:BABALOLA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 BECKETT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:499 BECKETT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1766
Practice Address - Country:US
Practice Address - Phone:856-467-6205
Practice Address - Fax:856-467-6590
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist