Healthcare Provider Details

I. General information

NPI: 1639691819
Provider Name (Legal Business Name): WILLIAM ADAMS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SE G ST
GRANTS PASS OR
97526-3066
US

IV. Provider business mailing address

12703 LAKE WILDERNESS LN
SPOTSYLVANIA VA
22551-8122
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-1583
  • Fax:
Mailing address:
  • Phone: 541-916-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62324
License Number StateOR

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: