Modupeola Motomori Agboola, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1170710 Issued in TX

Practice address

5717 Country View LN
Frisco, TX 75034-4637

Phone

(214) 470-1899

Fax

(214) 469-2717

NPI assigned

Sep 27, 2006

Last updated

Dec 12, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229040000000",
    "number": "1659462893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5717 COUNTRY VIEW LN",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750344637",
            "telephone_number": "214-470-1899",
            "fax_number": "214-469-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5717 COUNTRY VIEW LN",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750344637",
            "telephone_number": "214-470-1899",
            "fax_number": "214-469-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBOOLA",
        "first_name": "MODUPEOLA",
        "middle_name": "MOTOMORI",
        "name_prefix": "Miss",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2008-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "19515",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00933200",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1170710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Frisco, TX
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; 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.