Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 3951 | AZ |
N | 2251N0400X | Physical Therapist - Neurology | 3951 | AZ |
N | 2251P0200X | Physical Therapist - Pediatrics | 3951 | AZ |
NPI | 1265521702 |
---|---|
Provider Name | Mr. Adebola Adekanmbi |
First Address | Glendale, AZ 85301-8111 |
Second Address | Glendale, AZ 85301-8111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |