Provider Demographics
NPI:1902536279
Name:OGUNOLA, EBUNOLUWA ABODUNRIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:EBUNOLUWA
Middle Name:ABODUNRIN
Last Name:OGUNOLA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0457
Mailing Address - Country:US
Mailing Address - Phone:928-755-4893
Mailing Address - Fax:928-755-4934
Practice Address - Street 1:HIGHWAY 264 & HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-0457
Practice Address - Country:US
Practice Address - Phone:928-755-4893
Practice Address - Fax:928-755-4934
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist