Provider Demographics
NPI:1902145808
Name:OLUFAYO, OLUKAYODE (DPT)
Entity Type:Individual
Prefix:MR
First Name:OLUKAYODE
Middle Name:
Last Name:OLUFAYO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5193 MUDVILLE LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-4217
Mailing Address - Country:US
Mailing Address - Phone:301-605-5955
Mailing Address - Fax:
Practice Address - Street 1:5193 MUDVILLE LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-4217
Practice Address - Country:US
Practice Address - Phone:301-605-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24459OtherPHYSICAL THERAPY