Healthcare Provider Details

I. General information

NPI: 1689838260
Provider Name (Legal Business Name): GREGORY M ADLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WELLSLEY WAY
PADUCAH KY
42003
US

IV. Provider business mailing address

221 WELLSLEY WAY
PADUCAH KY
42003-8827
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-5012
  • Fax:
Mailing address:
  • Phone: 270-554-5012
  • Fax: 270-994-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001338
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: