Active NPI
Olalekan Lukman Ganiyu, PT, MHSC, MTC
- Physical Therapy Clinic/Center
- Glendale, WI
National Provider Identifier
1366548919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 024- 5648
- Practice address
- 2500 W Silver Spring Dr
Ste a
Glendale, WI 53209-4218 - Phone
- (608) 368-9783
- Fax
- (608) 368-9784
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Clinic/Center | 261QP2000X | 024- 5648 | WI | Primary |
Addresses
Primary practice location
2500 W Silver Spring Dr
Ste a
Glendale, WI 53209-4218
Mailing address
2500 W Silver Spring Dr
Ste a
Glendale, WI 53209-4218
Phone (608) 368-9783
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40403900 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024- 5648 | WI | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566432000000",
"number": "1366548919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 W SILVER SPRING DR",
"address_2": "STE A",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532094218",
"telephone_number": "608-368-9783",
"fax_number": "608-368-9784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 W SILVER SPRING DR",
"address_2": "STE A",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532094218",
"telephone_number": "608-368-9783",
"fax_number": "608-368-9784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANIYU",
"first_name": "OLALEKAN",
"middle_name": "LUKMAN",
"credential": "PT, MHSC, MTC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2019-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "WI",
"license": "024- 5648",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40403900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.