Provider Demographics
NPI:1639301674
Name:SANGOSENI, OLAIDE (DPT, MSCPT, PHD)
Entity Type:Individual
Prefix:DR
First Name:OLAIDE
Middle Name:
Last Name:SANGOSENI
Suffix:
Gender:F
Credentials:DPT, MSCPT, PHD
Other - Prefix:DR
Other - First Name:OLAIDE
Other - Middle Name:
Other - Last Name:OLUWOLESANGOSENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT, MSCPT, PHD
Mailing Address - Street 1:650 MARYVILLE UNIVERSITY DR
Mailing Address - Street 2:PHYSICAL THERAPY PROGRAM
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 MARYVILLE UNIVERSITY DR
Practice Address - Street 2:PHYSICAL THERAPY PROGRAM
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5849
Practice Address - Country:US
Practice Address - Phone:314-529-9257
Practice Address - Fax:314-529-9495
Is Sole Proprietor?:No
Enumeration Date:2009-08-09
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007019090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist