Provider Demographics
NPI:1922209097
Name:AKINBOBUYI, HENRY (PT)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:AKINBOBUYI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W 63RD CT
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2868
Mailing Address - Country:US
Mailing Address - Phone:219-616-8842
Mailing Address - Fax:
Practice Address - Street 1:6966 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3696
Practice Address - Country:US
Practice Address - Phone:219-616-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003850A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00398103OtherRAILROAD MEDICARE
IN247620FMedicare ID - Type Unspecified