Provider Demographics
NPI:1952061335
Name:AWOMOYI, AGNES ABIOLA OLUWATOYIN
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:ABIOLA OLUWATOYIN
Last Name:AWOMOYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34049 WELBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:UPPERVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20184-3121
Mailing Address - Country:US
Mailing Address - Phone:540-326-2478
Mailing Address - Fax:
Practice Address - Street 1:44110 ASHBURN SHOPPING PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3999
Practice Address - Country:US
Practice Address - Phone:571-279-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist