Oluwadare Samson Kolurejo

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1351279 Issued in TX

Practice address

2210 Rustic Chapel CT
Fresno, TX 77545-2211

Phone

(832) 759-4200

NPI assigned

May 7, 2021

Last updated

Mar 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DTF Koluz LLC

  • Physical Therapist
  • Fresno, TX
  • NPI 1235088683
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1083298988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 RUSTIC CHAPEL CT",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "775452211",
            "telephone_number": "832-759-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 RUSTIC CHAPEL CT",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "775452211",
            "telephone_number": "832-759-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLUREJO",
        "first_name": "OLUWADARE",
        "middle_name": "SAMSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-07",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1351279",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2161394",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS ID",
            "identifier": "43674520",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "43674520",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rakhi Krishnakumar, PMHNP-BC
• Kroger Texas L P (Kroger Pharmacy)
• La Hold Services LLC
• Adam Coy Lacks, CSFA, CST

• Physical Therapist in Fresno, TX
• Providers in Fresno, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.