Provider Demographics
NPI:1922416718
Name:AYEDUN, FESTUS ROTIMI (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:FESTUS
Middle Name:ROTIMI
Last Name:AYEDUN
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 1:6603 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5713
Mailing Address - Country:US
Mailing Address - Phone:917-674-0367
Mailing Address - Fax:718-531-3546
Practice Address - Street 1:6603 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5713
Practice Address - Country:US
Practice Address - Phone:917-674-0367
Practice Address - Fax:718-531-3546
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist