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NPI Code Detail

MEDICARE: MS. SERAH IYABODE AYOOLA DPT

MEDICARE: MS. SERAH IYABODE AYOOLA DPT
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
1225100000XPhysical TherapistPT009565GA

General Provider Information

NPI Number : 1831329663
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SERAH IYABODE AYOOLA DPT
Provider Business Mailing Address
First Line : 6397 LEE HWY
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-2564
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2838 E ATLANTA RD STE 2
Second Line :
City : ELLENWOOD
State : GA
Zip : 30294-2780
Country : US
Telephone Number : 678-782-3609
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2009
Last Update Date : 04/13/2022

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