Provider Demographics
NPI:1750048351
Name:ADENISEUN, LAWRENCE OLUWATOYIN (DPT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:OLUWATOYIN
Last Name:ADENISEUN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 CREEK POINT LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3329
Mailing Address - Country:US
Mailing Address - Phone:817-504-9453
Mailing Address - Fax:
Practice Address - Street 1:5335 W SUBLETT RD STE 151
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1185
Practice Address - Country:US
Practice Address - Phone:817-839-9150
Practice Address - Fax:972-979-6951
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1353023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist