Provider Demographics
NPI:1104035559
Name:AKANDE, OLAKUNLE WASIU (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:OLAKUNLE
Middle Name:WASIU
Last Name:AKANDE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12973 RILEY CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8850
Mailing Address - Country:US
Mailing Address - Phone:562-964-1255
Mailing Address - Fax:
Practice Address - Street 1:12973 RILEY CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8850
Practice Address - Country:US
Practice Address - Phone:562-964-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27702Medicare ID - Type UnspecifiedPHYSICAL THERAPIST