Healthcare Provider Details

I. General information

NPI: 1629456157
Provider Name (Legal Business Name): NICHOLAS ADAMS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2015
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N BROAD ST
PHILADELPHIA PA
19121-3302
US

IV. Provider business mailing address

8520 BRIDLE RD
PHILADELPHIA PA
19111
US

V. Phone/Fax

Practice location:
  • Phone: 215-204-2488
  • Fax:
Mailing address:
  • Phone: 610-301-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberRT006244
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: