Akinboyenle Samson Akinola

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

012572 Issued in CT

Practice address

193 Main St
Apt 2
West Haven, CT 06516-4534

Phone

(475) 441-0360

NPI assigned

Jan 20, 2021

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 13, 2022.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644710400000",
    "number": "1306436639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "193 MAIN ST",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164534",
            "telephone_number": "475-441-0360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 MAIN ST",
            "address_2": "APT 2",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164534",
            "telephone_number": "475-441-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AKINOLA",
        "first_name": "AKINBOYENLE",
        "middle_name": "SAMSON",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-20",
        "last_updated": "2022-02-13",
        "certification_date": "2022-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": "CT",
            "license": "012572",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "012572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.fastrehabservices.com",
            "affiliation": "N",
            "endpointDescription": "official website",
            "address_1": "193 Main St",
            "city": "West Haven",
            "state": "CT",
            "country_code": "US",
            "postal_code": "065164534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in West Haven, CT
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.