Healthcare Provider Details

I. General information

NPI: 1851496772
Provider Name (Legal Business Name): ADRIAN DAREN CAMERON LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 6TH AVE E
TUSCALOOSA AL
35401-3207
US

IV. Provider business mailing address

PO BOX 2817
TUSCALOOSA AL
35403-2817
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-1211
  • Fax: 205-722-1009
Mailing address:
  • Phone: 205-759-1211
  • Fax: 205-722-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 617
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: