Provider Demographics
NPI:1245512052
Name:OLOWE, OLUBUNMI
Entity type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:OLOWE
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 1:1600 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1304
Mailing Address - Country:US
Mailing Address - Phone:312-243-5582
Mailing Address - Fax:
Practice Address - Street 1:1600 W 13TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1304
Practice Address - Country:US
Practice Address - Phone:312-243-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010706A225100000X
IL070018560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist