Healthcare Provider Details

I. General information

NPI: 1730205543
Provider Name (Legal Business Name): ADAM HARNER M.S.P.T, D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDREN'S WAY MC5068
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDREN'S WAY MC5068
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5829
  • Fax: 858-966-5859
Mailing address:
  • Phone: 858-966-5829
  • Fax: 858-966-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30379
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15075
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT30379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: