Provider Demographics
NPI:1356106249
Name:AJIBOYE, BOSEDE
Entity type:Individual
Prefix:
First Name:BOSEDE
Middle Name:
Last Name:AJIBOYE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2617
Mailing Address - Country:US
Mailing Address - Phone:202-903-5927
Mailing Address - Fax:
Practice Address - Street 1:415 MCFARLAN RD STE 200
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2454
Practice Address - Country:US
Practice Address - Phone:484-720-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist