Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1003484684 |
---|---|
Provider Name | Ogoluwakitan Cal Lawanson |
First Address | Columbia, MO 65201-8286 |
Second Address | Atlanta, GA 30327-5308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 11/06/2021 |