Provider Demographics
NPI:1861604837
Name:OLUSINA, OLAIDE BABATOPE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:OLAIDE
Middle Name:BABATOPE
Last Name:OLUSINA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3292
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-3292
Mailing Address - Country:US
Mailing Address - Phone:804-928-8771
Mailing Address - Fax:804-449-1939
Practice Address - Street 1:15411 BEAVER DEN LN
Practice Address - Street 2:
Practice Address - City:BEAVERDAM
Practice Address - State:VA
Practice Address - Zip Code:23015-2000
Practice Address - Country:US
Practice Address - Phone:804-928-8771
Practice Address - Fax:804-449-1939
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist