MEDICARE: MISS ADEBISI ABIODUN OKEYEMI PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	014897	NY
2	225100000X	Physical Therapist	014897	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	QA022	OTHER	NY	MEDICARE NO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558319483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ADEBISI ABIODUN OKEYEMI PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	528 ROCKAWAY AVE
Second Line	:	1ST FLR
City	:	BROOKLYN
State	:	NY
Zip	:	11212
Country	:	US
Telephone Number	:	718-207-3413
Fax Number	:	718-493-2775

Provider Business Practice Location Address
First Line	:	528 ROCKAWAY AV
Second Line	:	2 FLR
City	:	BROOKLYN
State	:	NY
Zip	:	11212-5636
Country	:	US
Telephone Number	:	718-207-3413
Fax Number	:	718-493-2775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/16/2013

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Directions to “ MISS ADEBISI ABIODUN OKEYEMI PHYSICAL THERAPIST” Practice Location

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