Provider Demographics
NPI:1801423249
Name:FASHOYIN, OLUGBUYI DARE (PT)
Entity type:Individual
Prefix:
First Name:OLUGBUYI
Middle Name:DARE
Last Name:FASHOYIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10103 FONDREN RD # 150A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4556
Mailing Address - Country:US
Mailing Address - Phone:713-588-4881
Mailing Address - Fax:281-206-4664
Practice Address - Street 1:10103 FONDREN RD # 150A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4556
Practice Address - Country:US
Practice Address - Phone:713-588-4881
Practice Address - Fax:281-206-4664
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1286599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist