Provider Demographics
NPI:1578063509
Name:BELONI, OPEYEMI SAMUEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:SAMUEL
Last Name:BELONI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-4923
Mailing Address - Country:US
Mailing Address - Phone:609-643-1267
Mailing Address - Fax:
Practice Address - Street 1:349 W 22ND ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4923
Practice Address - Country:US
Practice Address - Phone:609-643-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist