Most Relevant Information
Provider Data
| NPI Number: | 1003651282 |
| Provider Name: | SIDNEY OTIWU PT, DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | PT017162 |
Most Important Dates
| Enumeration Date: | 06/28/2024 |
| Last Updated: | 06/28/2024 |
Provider Practice Location
575 PROFESSIONAL DR STE 370
LAWRENCEVILLE
GA
300463334
Practice Location Phone/Fax
| Phone: | 6782055420 |
| Fax: | 6782055462 |
Provider Mailing Location
2400 WISTERIA DR STE A
SNELLVILLE
GA
300782689
Provider Mailing Phone/Fax
| Phone: | 7709820102 |
| Fax: | 7709820130 |