Provider Demographics
NPI:1760117105
Name:ADEYEMO, CHRISTIANAH (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIANAH
Middle Name:
Last Name:ADEYEMO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WESTHEIMER RD APT 1211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3544
Mailing Address - Country:US
Mailing Address - Phone:915-549-9501
Mailing Address - Fax:
Practice Address - Street 1:5151 BUFFALO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4271
Practice Address - Country:US
Practice Address - Phone:713-432-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2170806225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant