Healthcare Provider Details

I. General information

NPI: 1043553597
Provider Name (Legal Business Name): ADAMS SPORTS MEDICINE & PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46001 GRAND RIVER AVE SUITE A
NOVI MI
48374-1319
US

IV. Provider business mailing address

46001 GRAND RIVER AVE SUITE A
NOVI MI
48374-1319
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-3003
  • Fax: 248-513-3004
Mailing address:
  • Phone: 248-513-3003
  • Fax: 248-513-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN J ADAMS
Title or Position: OWNER
Credential: PT, DPT, OCS, CSCS
Phone: 248-513-3003