Individual provider Active NPI

Tiwalade Obisesan

  • Physical Therapy Assistant
  • Sugar Land, TX
National Provider Identifier
1710295126
Registry record updated Sep 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
2077931 Issued in TX
Practice address
2323 Upland Park Dr
Sugar Land, TX 77479-7032
Phone
(832) 492-3818
NPI assigned
Sep 20, 2010
Last updated
Sep 20, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2077931 TX Primary

Addresses

Primary practice location

2323 Upland Park Dr
Sugar Land, TX 77479-7032

Mailing address

2323 Upland Park Dr
Sugar Land, TX 77479-7032

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

LicenseStateTypeSpecialty
2077931TXMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284940800000",
    "number": "1710295126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 UPLAND PARK DR",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774797032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 UPLAND PARK DR",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774797032",
            "telephone_number": "832-492-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBISESAN",
        "first_name": "TIWALADE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-20",
        "last_updated": "2010-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2077931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sugar Land, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.