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General NPI Number Information
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NPI Number | 1659462893
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Entity Type | Individual
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Provider Name | MODUPEOLA MOTOMORI AGBOOLA DPT
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 5717 COUNTRY VIEW LN
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City | FRISCO
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State | TX
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Zip | 75034-4637
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Country | US
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Telephone | 214-470-1899
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Fax | 214-469-2717
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Provider Business Mailing Address
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Address Line | 5717 COUNTRY VIEW LN
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City | FRISCO
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State | TX
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Zip | 75034-4637
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Country | US
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Telephone | 214-470-1899
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Fax | 214-469-2717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 19515
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00933200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1170710
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License Number State | TX
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