Active NPI
Mobolaji Johnson Omotosho, DPT
- Physical Therapist
- El Paso, TX
National Provider Identifier
1235496845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1216728
- Practice address
- 6028 Surety Dr
El Paso, TX 79905-2024 - Phone
- (915) 771-8523
- NPI assigned
- Apr 19, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1216728 | TX | Primary |
Addresses
Primary practice location
6028 Surety Dr
El Paso, TX 79905-2024
Mailing address
12121 Pellicano Dr
Apt 112
El Paso, TX 79936-6835
Phone (915) 861-9977
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92262701 | Medicaid | TX | |
| 310252YNCD | Other | TX | MEDICARE PTAN THERAPY CONSULTANTS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379980800000",
"number": "1235496845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12121 PELLICANO DR",
"address_2": "APT 112",
"city": "EL PASO",
"state": "TX",
"postal_code": "799366835",
"telephone_number": "915-861-9977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6028 SURETY DR",
"city": "EL PASO",
"state": "TX",
"postal_code": "799052024",
"telephone_number": "915-771-8523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMOTOSHO",
"first_name": "MOBOLAJI",
"middle_name": "JOHNSON",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-19",
"last_updated": "2013-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1216728",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "92262701",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN THERAPY CONSULTANTS",
"identifier": "310252YNCD",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.