Provider Demographics
NPI:1386818128
Name:ADEYEMI, ADEREMI ISOLA (PT)
Entity Type:Individual
Prefix:
First Name:ADEREMI
Middle Name:ISOLA
Last Name:ADEYEMI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BEACH 92ND ST
Mailing Address - Street 2:APT 1
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1540
Mailing Address - Country:US
Mailing Address - Phone:718-634-3727
Mailing Address - Fax:718-835-5008
Practice Address - Street 1:214 BEACH 92ND ST
Practice Address - Street 2:1
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1540
Practice Address - Country:US
Practice Address - Phone:718-634-3727
Practice Address - Fax:718-835-5008
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist