Provider Demographics
NPI:1518531458
Name:OLADIPUPO, LANRE SODIQ (PT DPT)
Entity Type:Individual
Prefix:
First Name:LANRE
Middle Name:SODIQ
Last Name:OLADIPUPO
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 1:1133 E MOUNT AIRY AVE APT B12
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2915
Mailing Address - Country:US
Mailing Address - Phone:267-206-2116
Mailing Address - Fax:
Practice Address - Street 1:1609 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4850
Practice Address - Country:US
Practice Address - Phone:575-935-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist