Provider Demographics
NPI:1801533708
Name:ADEOGUN, ABIODUN AKANBI (PT)
Entity type:Individual
Prefix:DR
First Name:ABIODUN
Middle Name:AKANBI
Last Name:ADEOGUN
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 1:3964 CHESTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2870
Mailing Address - Country:US
Mailing Address - Phone:347-702-3885
Mailing Address - Fax:
Practice Address - Street 1:3964 CHESTERWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2870
Practice Address - Country:US
Practice Address - Phone:347-702-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047210225100000X
MD29393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist