Provider Demographics
NPI:1134248743
Name:AGHOMO, OLUTOYIN O (PT)
Entity type:Individual
Prefix:
First Name:OLUTOYIN
Middle Name:O
Last Name:AGHOMO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 EVESHAM DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3818
Mailing Address - Country:US
Mailing Address - Phone:214-693-7745
Mailing Address - Fax:214-377-9254
Practice Address - Street 1:3820 EVESHAM DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3818
Practice Address - Country:US
Practice Address - Phone:214-693-7745
Practice Address - Fax:214-377-9254
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist