Provider Demographics
NPI:1750956389
Name:PROVEN PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:PROVEN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAYINKA
Authorized Official - Middle Name:GBENGA
Authorized Official - Last Name:FOLAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-899-2251
Mailing Address - Street 1:3410 MANDERES PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2526
Mailing Address - Country:US
Mailing Address - Phone:240-899-2251
Mailing Address - Fax:
Practice Address - Street 1:3410 MANDERES PL
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-2526
Practice Address - Country:US
Practice Address - Phone:240-899-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy