Olusegun Bodunrin Ayadi Jr., PT, DPT, CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1337885 Issued in TX

Practice address

751 S Beckham Ave
Tyler, TX 75701-1903

Phone

(903) 707-8099

Fax

(903) 258-9194

NPI assigned

Aug 31, 2020

Last updated

Sep 8, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Meredith S. Tittle, P.T., LLCGroup PAC ID 9830491596, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Meredith S. Tittle, P.T., LLC

  dba S2S Functional Performance

  • Physical Therapy Clinic/Center
  • Flower Mound, TX
  • NPI 1245553395

  Physical Therapist

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1639783442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011903",
            "telephone_number": "903-707-8099",
            "fax_number": "903-258-9194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011903",
            "telephone_number": "903-707-8099",
            "fax_number": "903-258-9194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYADI",
        "first_name": "OLUSEGUN",
        "middle_name": "BODUNRIN",
        "name_suffix": "Jr.",
        "credential": "PT, DPT, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-31",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1337885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cristina Yadira Avellaneda, RN
• Elizabeth Avila Santiago
• Mikel Josh Alarcon Aviso, APRN, PMHNP-BC
• Olanrewaju Awofeso
• Axis Counseling & Wellness PLLC
• Julie Ayala, D.O.
• Madiha Ayaz, MD
• Nelly Ngweh Ayen, PHARMD
• Phillip Ayers
• Austilar Ayoka

• Physical Therapist in Tyler, TX
• Providers in Tyler, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.