Provider Demographics
NPI:1376364810
Name:OKETADE, ZAINAB (PT,DPT)
Entity type:Individual
Prefix:
First Name:ZAINAB
Middle Name:
Last Name:OKETADE
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 BECKENHAM PL
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6816
Mailing Address - Country:US
Mailing Address - Phone:678-677-1479
Mailing Address - Fax:
Practice Address - Street 1:150 ATHENS HWY STE 600
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4968
Practice Address - Country:US
Practice Address - Phone:770-554-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0174552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic