Provider Demographics
NPI:1356774921
Name:OGUNSOLA-SMITH, OLUWATITOYIN (PT, DPT, AT)
Entity type:Individual
Prefix:
First Name:OLUWATITOYIN
Middle Name:
Last Name:OGUNSOLA-SMITH
Suffix:
Gender:F
Credentials:PT, DPT, AT
Other - Prefix:
Other - First Name:TITO
Other - Middle Name:
Other - Last Name:OGUNSOLA-SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4315 W SANTIAGO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7723
Mailing Address - Country:US
Mailing Address - Phone:813-453-9896
Mailing Address - Fax:
Practice Address - Street 1:4315 W SANTIAGO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7723
Practice Address - Country:US
Practice Address - Phone:813-453-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist