Provider Demographics
NPI:1902417967
Name:JIMOH, ORIMASHE ABDULSALAM
Entity Type:Individual
Prefix:
First Name:ORIMASHE
Middle Name:ABDULSALAM
Last Name:JIMOH
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 1:3839 SAINT BARNABAS RD APT 204
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3233
Mailing Address - Country:US
Mailing Address - Phone:909-602-9426
Mailing Address - Fax:
Practice Address - Street 1:1801 RICHIE STATION COURT
Practice Address - Street 2:SUITE 200
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743
Practice Address - Country:US
Practice Address - Phone:240-455-9400
Practice Address - Fax:240-455-9401
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty