Provider Demographics
NPI:1548584097
Name:OLAFIMIHAN, LATIFAT OMOTAYO (PT)
Entity Type:Individual
Prefix:DR
First Name:LATIFAT
Middle Name:OMOTAYO
Last Name:OLAFIMIHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LATIFAT
Other - Middle Name:OMOTAYO
Other - Last Name:OLADIPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14730 JASPER STREAM CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-1562
Mailing Address - Country:US
Mailing Address - Phone:301-366-9315
Mailing Address - Fax:281-424-7567
Practice Address - Street 1:3818 DECKER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1662
Practice Address - Country:US
Practice Address - Phone:281-424-7557
Practice Address - Fax:281-424-7567
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1302820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist