Provider Demographics
NPI:1942267059
Name:OSUNSANMI, OLUGBENGA O (DPT)
Entity Type:Individual
Prefix:DR
First Name:OLUGBENGA
Middle Name:O
Last Name:OSUNSANMI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:OLU
Other - Middle Name:O
Other - Last Name:OSUNSANMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:6127 E CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4209
Mailing Address - Country:US
Mailing Address - Phone:316-259-3413
Mailing Address - Fax:316-260-2426
Practice Address - Street 1:6127 E CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4209
Practice Address - Country:US
Practice Address - Phone:316-259-3413
Practice Address - Fax:316-260-2426
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200298830AMedicaid
KSP00237367OtherRR MEDICARE
KS14274OtherPHS
KS203667OtherHPK
KS140812OtherBLUE CROSS BLUE SHIELD
KSQ37623Medicare UPIN
KS200298830AMedicaid