Olukayode Fasuba

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P17780 Issued in NC

Practice address

6030 Harkey Rd Apt 8201
Matthews, NC 28105-5962

Phone

(252) 347-1595

NPI assigned

Jul 19, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Paragon Outpatient Rehabilitation Services, LLC

  dba Synchrony Rehabilitation

  • Rehabilitation Clinic/Center
  • Louisville, KY
  • NPI 1871867325

  NC

  Medicare reassignment

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

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1720651649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6030 HARKEY RD APT 8201",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055962",
            "telephone_number": "252-347-1595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 HARKEY RD APT 8201",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055962",
            "telephone_number": "252-347-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASUBA",
        "first_name": "OLUKAYODE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-19",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NC",
            "license": "P17780",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P17780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelley Jane Everts, FNP
• Stephen James Ezzo, M.D,
• Derek Farmen
• Edith Ann Farr, APRN
• Sandra R Farrelly, RN
• Zayd Fattah
• Jessica Lynn Faulk
• Tarah Faust, PTA
• FBTC Transitional Sub, LLC (Bright Light)
• FBTC Transitional Sub, LLC (Whole Health Behavioral Solutions)

• Physical Therapist in Matthews, NC
• Providers in Matthews, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.