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NPI Code Detail

MEDICARE: MS. BROADWIN B ADESEGUN DPT

MEDICARE: MS. BROADWIN B ADESEGUN 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 Therapist2305204402VA

General Provider Information

NPI Number : 1548349996
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BROADWIN B ADESEGUN DPT
Provider Business Mailing Address
First Line : 657 NATHANIEL CHASE LN
Second Line :
City : HERNDON
State : VA
Zip : 20170-4970
Country : US
Telephone Number : 703-826-3743
Fax Number : 206-339-2959
Provider Business Practice Location Address
First Line : 43490 YUKON DR STE 212
Second Line :
City : ASHBURN
State : VA
Zip : 20147-7326
Country : US
Telephone Number : 703-729-7920
Fax Number : 703-729-7923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 10/17/2022

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