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General NPI Number Information
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NPI Number | 1073614285
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Entity Type | Individual
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Provider Name | ADAM M WILLIS P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 206 GLEN ST SUITE #52
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City | GLENS FALLS
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State | NY
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Zip | 12801-3584
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Country | US
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Telephone | 518-538-8778
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Fax | 518-636-3204
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Provider Business Mailing Address
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Address Line | 221 MAIN ST
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City | SOUTH GLENS FALLS
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State | NY
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Zip | 12803-5118
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Country | US
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Telephone | 518-225-5049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305204833
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00010625
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 027046-1
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License Number State | NY
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