Provider Demographics
NPI:1902016637
Name:ADEWUNMI, MODUPE ADEBOWALE
Entity Type:Individual
Prefix:
First Name:MODUPE
Middle Name:ADEBOWALE
Last Name:ADEWUNMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MODUPE
Other - Middle Name:ADEBOWALE
Other - Last Name:ADEBANJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4500 CONNECTICUT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4326
Mailing Address - Country:US
Mailing Address - Phone:202-882-6988
Mailing Address - Fax:
Practice Address - Street 1:4500 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4326
Practice Address - Country:US
Practice Address - Phone:202-882-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist