Active NPI
Oludare Ewetusa, PTA
- Physical Therapy Assistant
- Fairfax, VA
National Provider Identifier
1487165973
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Aug 20, 2026.
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2306604918
- Practice address
- 11166 Fairfax Blvd Ste 500
Fairfax, VA 22030-5017 - Phone
- (571) 464-0961
- NPI assigned
- Oct 24, 2017
- Last updated
- Nov 5, 2025
- 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 Assistant | 225200000X | 2306604918 | VA | Primary |
Addresses
Primary practice location
11166 Fairfax Blvd Ste 500
Fairfax, VA 22030-5017
Mailing address
11166 Fairfax Blvd Ste 500
Fairfax, VA 22030-5017
Phone (571) 464-0961
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2306604918 | VA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762300800000",
"number": "1487165973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11166 FAIRFAX BLVD STE 500",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220305017",
"telephone_number": "571-464-0961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11166 FAIRFAX BLVD STE 500",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220305017",
"telephone_number": "571-464-0961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWETUSA",
"first_name": "OLUDARE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-24",
"last_updated": "2025-11-05",
"certification_date": "2025-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "VA",
"license": "2306604918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.