Provider Demographics
NPI:1881109882
Name:KOLAWOLE, ADEYINKA
Entity type:Individual
Prefix:
First Name:ADEYINKA
Middle Name:
Last Name:KOLAWOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6188 OXON HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3149
Mailing Address - Country:US
Mailing Address - Phone:301-856-5860
Mailing Address - Fax:
Practice Address - Street 1:6188 OXON HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3149
Practice Address - Country:US
Practice Address - Phone:301-856-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist