Provider Demographics
NPI:1508092446
Name:OLURINDE, ADEDOLAPO ADESHOLA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ADEDOLAPO
Middle Name:ADESHOLA
Last Name:OLURINDE
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 1:24104 148TH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3249
Mailing Address - Country:US
Mailing Address - Phone:718-481-7929
Mailing Address - Fax:718-481-7929
Practice Address - Street 1:24104 148TH RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3249
Practice Address - Country:US
Practice Address - Phone:718-481-7929
Practice Address - Fax:718-481-7929
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023029-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist