Provider Demographics
NPI:1710197538
Name:ADEROBA, OLUMIDE T (PTDPTMSGCS)
Entity Type:Individual
Prefix:DR
First Name:OLUMIDE
Middle Name:T
Last Name:ADEROBA
Suffix:
Gender:M
Credentials:PTDPTMSGCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2325 WESTGATE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-0728
Mailing Address - Country:US
Mailing Address - Phone:931-540-0665
Mailing Address - Fax:
Practice Address - Street 1:5226 COLUMBIA PIKE
Practice Address - Street 2:SUITE3, BUILDING D
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-7409
Practice Address - Country:US
Practice Address - Phone:615-302-1371
Practice Address - Fax:615-302-0271
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist