Provider Demographics
NPI:1902178825
Name:AKINBOLA, MICHAEL (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AKINBOLA
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E DELAWARE AVE
Mailing Address - Street 2:053 MCKINLY LAB
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19716-3798
Mailing Address - Country:US
Mailing Address - Phone:302-831-8893
Mailing Address - Fax:302-831-4468
Practice Address - Street 1:63 E DELAWARE AVE
Practice Address - Street 2:053 MCKINLY LAB
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-3798
Practice Address - Country:US
Practice Address - Phone:302-831-8893
Practice Address - Fax:302-831-4468
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEJ1-0002821OtherDELAWARE DEPARTMENT OF STATE PT LICENSE