Provider Demographics
NPI:1790921195
Name:OBAJULUWA, VICTOR A (PT, PHD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:A
Last Name:OBAJULUWA
Suffix:
Gender:M
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6776 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3458
Mailing Address - Country:US
Mailing Address - Phone:219-670-9361
Mailing Address - Fax:219-980-8168
Practice Address - Street 1:3816 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-2150
Practice Address - Country:US
Practice Address - Phone:219-981-8109
Practice Address - Fax:219-980-8168
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN68000036A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist