Provider Demographics
NPI:1437879244
Name:AKINTAYO, AKINTUNDE OLUSOLA (DPT)
Entity Type:Individual
Prefix:DR
First Name:AKINTUNDE
Middle Name:OLUSOLA
Last Name:AKINTAYO
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 1:4022 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2314
Mailing Address - Country:US
Mailing Address - Phone:347-400-5339
Mailing Address - Fax:
Practice Address - Street 1:799 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6107
Practice Address - Country:US
Practice Address - Phone:718-881-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist