Healthcare Provider Details

I. General information

NPI: 1376525220
Provider Name (Legal Business Name): JODIE MAE ADAMS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODIE MAE PADGETT

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20055 SW PACIFIC HWY STE 110
SHERWOOD OR
97140-9294
US

IV. Provider business mailing address

1700 BROADWAY ST.
VANCOUVER WA
98663
US

V. Phone/Fax

Practice location:
  • Phone: 503-625-1691
  • Fax: 503-926-1460
Mailing address:
  • Phone: 360-737-3346
  • Fax: 360-694-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5033
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60119188
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: