Healthcare Provider Details

I. General information

NPI: 1124942677
Provider Name (Legal Business Name): JELANI AKONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 W 38TH AVE UNIT A124
WHEAT RIDGE CO
80033-6170
US

IV. Provider business mailing address

120 PIKES PEAK PL
DILLON CO
80435-5558
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-1594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-005114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: