Provider Demographics
NPI:1881929164
Name:OYELOLA, MESSAIAH OYELOLA (PT)
Entity type:Individual
Prefix:
First Name:MESSAIAH
Middle Name:OYELOLA
Last Name:OYELOLA
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:ILA-ODO,
Mailing Address - Street 2:
Mailing Address - City:OSOGBO
Mailing Address - State:OSUN
Mailing Address - Zip Code:0000
Mailing Address - Country:NG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 HENRIETTA STREET
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:347-675-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist