Healthcare Provider Details

I. General information

NPI: 1184196792
Provider Name (Legal Business Name): ALICIA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 SWEET GRASS DR SE
CALEDONIA MI
49316-7309
US

IV. Provider business mailing address

2100 RAYBROOK ST SE STE 300
GRAND RAPIDS MI
49546-5783
US

V. Phone/Fax

Practice location:
  • Phone: 616-485-7587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: