Provider Demographics
NPI:1073220612
Name:AKINMOSIN, OLUGBENGA DAVID
Entity type:Individual
Prefix:MR
First Name:OLUGBENGA
Middle Name:DAVID
Last Name:AKINMOSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 MERIDIAN ST STE 170
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4343
Mailing Address - Country:US
Mailing Address - Phone:765-646-8663
Mailing Address - Fax:
Practice Address - Street 1:2020 MERIDIAN ST STE 170
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4343
Practice Address - Country:US
Practice Address - Phone:765-646-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011677A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist