Healthcare Provider Details

I. General information

NPI: 1679196612
Provider Name (Legal Business Name): ANDREW D ADAMS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SW HIGGINS AVE STE 2051001
MISSOULA MT
59803-1341
US

IV. Provider business mailing address

1001 SW HIGGINS AVE STE 2051001
MISSOULA MT
59803-1341
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-3096
  • Fax: 406-721-3956
Mailing address:
  • Phone: 406-721-3096
  • Fax: 406-721-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6720
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: