Provider Demographics
NPI:1407941768
Name:AKOMOLAFE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AKOMOLAFE PROFESSIONAL CORPORATION
Other - Org Name:THERAPY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:ADEKUNLE
Authorized Official - Last Name:AKOMOLAFE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, GCS
Authorized Official - Phone:915-849-6602
Mailing Address - Street 1:11351 JAMES WATT DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6605
Mailing Address - Country:US
Mailing Address - Phone:915-849-6602
Mailing Address - Fax:915-849-6603
Practice Address - Street 1:11351 JAMES WATT DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6605
Practice Address - Country:US
Practice Address - Phone:915-849-6602
Practice Address - Fax:915-849-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659380000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310893801Medicaid
TXTXB165795OtherMEDICARE PTAN