Provider Demographics
NPI:1235563693
Name:ADEYEMI, KOLAWOLE A (DPT)
Entity Type:Individual
Prefix:DR
First Name:KOLAWOLE
Middle Name:A
Last Name:ADEYEMI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18302 THICKET GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7596
Mailing Address - Country:US
Mailing Address - Phone:281-733-1356
Mailing Address - Fax:832-767-0037
Practice Address - Street 1:18302 THICKET GROVE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7596
Practice Address - Country:US
Practice Address - Phone:281-733-1356
Practice Address - Fax:832-767-0037
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1187289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist