Provider Demographics
NPI:1316032675
Name:AKOMOLAFE, BABATUNDE ADEKUNLE (PT, DPT, GCS)
Entity Type:Individual
Prefix:DR
First Name:BABATUNDE
Middle Name:ADEKUNLE
Last Name:AKOMOLAFE
Suffix:
Gender:M
Credentials:PT, DPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11351 JAMES WATT DR
Mailing Address - Street 2:STE. A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6627
Mailing Address - Country:US
Mailing Address - Phone:915-849-6602
Mailing Address - Fax:915-849-6603
Practice Address - Street 1:11351 JAMES WATT DR
Practice Address - Street 2:STE. A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6627
Practice Address - Country:US
Practice Address - Phone:915-849-6602
Practice Address - Fax:915-849-6603
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165796OtherMEDICARE PTAN
TX062995803Medicaid