Provider Demographics
NPI:1184761116
Name:BASHORUN, OLUWANISHOLA (MS PT)
Entity type:Individual
Prefix:MRS
First Name:OLUWANISHOLA
Middle Name:
Last Name:BASHORUN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 WURZBACH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2431
Mailing Address - Country:US
Mailing Address - Phone:940-337-4132
Mailing Address - Fax:
Practice Address - Street 1:5309 WURZBACH RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2431
Practice Address - Country:US
Practice Address - Phone:940-337-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3175225100000X
VA2305205701225100000X
TX1399638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1399638OtherSTATE LICENSE
VA2305205701OtherSTATE LICENSURE
AZ3175OtherSTATE LICENSE INFORMATION