Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 012572 | CT |
N | 2251G0304X | Physical Therapist - Geriatrics | 012572 | CT |
NPI | 1306436639 |
---|---|
Provider Name | Mr. Akinboyenle Samson Akinola |
First Address | West Haven, CT 06516-4534 |
Second Address | West Haven, CT 06516-4534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2021 |
Last Update Date | 13/02/2022 |