Provider Demographics
NPI:1760703219
Name:ADENIJI, ADEMOLA OLUKAYODE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ADEMOLA
Middle Name:OLUKAYODE
Last Name:ADENIJI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HUCKLEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-4807
Mailing Address - Country:US
Mailing Address - Phone:915-566-1101
Mailing Address - Fax:800-498-9815
Practice Address - Street 1:915 HUCKLEBERRY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4807
Practice Address - Country:US
Practice Address - Phone:915-566-1101
Practice Address - Fax:800-498-9815
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM348530501Medicare PIN