Provider Demographics
NPI:1457119117
Name:AKINOSHO, EMMANUEL O (LMT PTA)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:O
Last Name:AKINOSHO
Suffix:
Gender:M
Credentials:LMT PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7970 W GRAND PKWY S APT 8206
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5856
Mailing Address - Country:US
Mailing Address - Phone:225-892-6561
Mailing Address - Fax:225-612-6924
Practice Address - Street 1:7970 W GRAND PKWY S APT 8206
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5856
Practice Address - Country:US
Practice Address - Phone:225-892-6561
Practice Address - Fax:225-612-6924
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT138768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist