Provider Demographics
NPI:1093992182
Name:ASEIN, TEMITOPE ADEDAMOLA (PT)
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:ADEDAMOLA
Last Name:ASEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21321 KNIGHTBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2962
Mailing Address - Country:US
Mailing Address - Phone:708-539-7811
Mailing Address - Fax:
Practice Address - Street 1:21321 KNIGHTBRIDGE CT
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2962
Practice Address - Country:US
Practice Address - Phone:708-539-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568150OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
ILR00381Medicare PIN