Healthcare Provider Details

I. General information

NPI: 1730945163
Provider Name (Legal Business Name): ABIMBOLA FAGBEMI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 VERMONT AVE NW
WASHINGTON DC
20005-4905
US

IV. Provider business mailing address

3350 TOLEDO TER APT 332
HYATTSVILLE MD
20782-3228
US

V. Phone/Fax

Practice location:
  • Phone: 202-289-2266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30489
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002421
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: