Provider Demographics
NPI:1336355080
Name:TELLA, ADESOLA ABIGAIL (DPT)
Entity Type:Individual
Prefix:
First Name:ADESOLA
Middle Name:ABIGAIL
Last Name:TELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353A MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1104
Mailing Address - Country:US
Mailing Address - Phone:347-351-5869
Mailing Address - Fax:
Practice Address - Street 1:4319 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3101
Practice Address - Country:US
Practice Address - Phone:347-351-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist