Basic Information
| Provider Information | |||||||||
| NPI: | 1750048351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADENISEUN | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | OLUWATOYIN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 319 CREEK POINT LN | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760023329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175049453 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5335 W SUBLETT RD STE 151 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760171185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178399150 | ||||||||
| FaxNumber: | 9729796951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2021 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1353023 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.