MEDICARE: AYOOLA SOBOWALE

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
1	225100000X	Physical Therapist	070029522	IL

General Provider Information

NPI Number	:	1750252177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYOOLA SOBOWALE

Provider Business Mailing Address
First Line	:	4307 N SAWYER AVE UNIT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 E 55TH ST STE 305
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5576
Country	:	US
Telephone Number	:	773-667-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/21/2025

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Directions to “ AYOOLA SOBOWALE ” Practice Location

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