Provider Demographics
NPI:1386280162
Name:MAJEKODUNMI, ADEKUNLE MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ADEKUNLE
Middle Name:MICHAEL
Last Name:MAJEKODUNMI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 U ST NW APT 602
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3528
Mailing Address - Country:US
Mailing Address - Phone:856-381-2091
Mailing Address - Fax:
Practice Address - Street 1:5100 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5069
Practice Address - Country:US
Practice Address - Phone:856-381-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014513225100000X
VA2305212976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist