Individual provider Active NPI

Oluwaseyi Obanoyen

  • Physical Therapist
  • Fort Worth, TX
National Provider Identifier
1700209608
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1237597 Issued in TX
Practice address
101 Summit Ave
Fort Worth, TX 76102-2618
Phone
(682) 730-0004
NPI assigned
Jan 28, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1237597 TX Primary

Addresses

Primary practice location

101 Summit Ave
Fort Worth, TX 76102-2618

Mailing address

2001 Butterfield Rd Ste 1600
Downers Grove, IL 60515-1211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160629000988 TX Practitioner - Physical Therapist in Private Practice 9436440096 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

379 E FM
1382 Suite 100
Cedar Hill, TX 75104-6040
Phone (972) 460-4490

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.48
Improvement activities
40
Cost
71.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Spero Rehabilitation LLC Physical Therapist CurrentSince Jun 30, 2021 Accepting new patients
Texas Luna Care Physical Therapy LLC Physical Therapist CurrentSince Sep 22, 2021 Accepting new patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Jan 29, 2018 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Jan 29, 2018 Accepting new patients
Oakbend Medical Center Past Accepting new patients
Webster Surgical Specialty Hospital, LLC Past Accepting new patients

Locations

5800 Lonetree Blvd
Ste 101
Rocklin, CA 95765
Phone (916) 302-9200

790 Remington Blvd
Bolingbrook, IL 60440

2001 Butterfield Rd
Ste 1600
Downers Grove, IL 60515

17051 Dallas Pkwy
Ste 450
Addison, TX 75001
Phone (214) 272-8561

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

379 E FM 1382
Ste 100
Cedar Hill, TX 75104
Phone (972) 460-4490

2002 W Grand Pkwy N
Ste 125
Katy, TX 77449
Phone (281) 710-9001

23225 Kingsland Blvd
Ste 600
Katy, TX 77494
Phone (281) 395-9090

21938 Royal Montreal Dr
Katy, TX 77450
Phone (281) 944-0001

1180 E Prosper Trl
Ste 50
Prosper, TX 75078
Phone (469) 481-3031

180 State St
Ste 225
Southlake, TX 76092
Phone (682) 429-7066

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1700209608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BUTTERFIELD RD STE 1600",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SUMMIT AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761022618",
            "telephone_number": "682-730-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBANOYEN",
        "first_name": "OLUWASEYI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-28",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1237597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.