Provider Demographics
NPI:1215971551
Name:SOLADOYE, KAYODE GEORGE (DPT)
Entity type:Individual
Prefix:DR
First Name:KAYODE
Middle Name:GEORGE
Last Name:SOLADOYE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 CREIGHTON RD
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7340
Mailing Address - Country:US
Mailing Address - Phone:850-969-1726
Mailing Address - Fax:850-969-7926
Practice Address - Street 1:2629 CREIGHTON RD
Practice Address - Street 2:SUITE # 4
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7340
Practice Address - Country:US
Practice Address - Phone:850-969-1726
Practice Address - Fax:850-969-7926
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886975800Medicaid
FLY0597AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #