Basic Information
| Provider Information | |||||||||
| NPI: | 1578088936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ODUMESI | ||||||||
| FirstName: | OLUFEMI | ||||||||
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| Credential: | PT,GNA,CNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5636 MIDWOOD AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212124029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434693426 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5636 MIDWOOD AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212124029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434693426 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 26622 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.