Healthcare Provider Details

I. General information

NPI: 1528103116
Provider Name (Legal Business Name): AMY T ADAMO MED, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5747 MEMORIAL GYM UNIVERSITY OF MAINE
ORONO ME
04469-5747
US

IV. Provider business mailing address

37 DAVIS ST
OLD TOWN ME
04468-1304
US

V. Phone/Fax

Practice location:
  • Phone: 207-581-1046
  • Fax: 207-581-4474
Mailing address:
  • Phone: 207-827-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT250
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: