Individual
OLUDARE EWETUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
11166 FAIRFAX BLVD STE 500, FAIRFAX, VA 22030-5017
(571) 464-0961
Mailing address
11166 FAIRFAX BLVD STE 500, FAIRFAX, VA 22030-5017
(571) 464-0961
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306604918
VA
Other
Enumeration date
10/24/2017
Last updated
11/05/2025
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