Provider Demographics
NPI:1619458122
Name:ABASSI, ADERONKE M M (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:ADERONKE M
Middle Name:M
Last Name:ABASSI
Suffix:
Gender:F
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 1:8017 RIVER PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3343
Mailing Address - Country:US
Mailing Address - Phone:317-507-7934
Mailing Address - Fax:
Practice Address - Street 1:7420 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4343
Practice Address - Country:US
Practice Address - Phone:301-736-0240
Practice Address - Fax:301-736-9366
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209841225100000X
MD25613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist