Provider Demographics
NPI:1841202702
Name:OLOWE, OLALEKAN JOSEPH
Entity Type:Individual
Prefix:MR
First Name:OLALEKAN
Middle Name:JOSEPH
Last Name:OLOWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1221
Mailing Address - Country:US
Mailing Address - Phone:915-771-8523
Mailing Address - Fax:915-771-8046
Practice Address - Street 1:8700 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1221
Practice Address - Country:US
Practice Address - Phone:915-771-8523
Practice Address - Fax:915-771-8046
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX92262701Medicaid
TX678341Medicare ID - Type UnspecifiedMEDICARE
676504Medicare PIN