Healthcare Provider Details

I. General information

NPI: 1245367473
Provider Name (Legal Business Name): BRIAN J ADAMS PT, DPT, OCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
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 TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number5501010114
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501010114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: