Provider Demographics
NPI:1467726299
Name:FAKOLUJO, FAGBEMI
Entity Type:Individual
Prefix:DR
First Name:FAGBEMI
Middle Name:
Last Name:FAKOLUJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 MILAS WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7538
Mailing Address - Country:US
Mailing Address - Phone:215-595-8395
Mailing Address - Fax:
Practice Address - Street 1:9610 MILAS WAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7538
Practice Address - Country:US
Practice Address - Phone:215-595-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist