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General NPI Number Information
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NPI Number | 1184954919
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Entity Type | Organization
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Legal Business Name | TRACY D. ADAMS ET AL PTR
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 1905 FLORENCE BLVD SUITE F
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City | FLORENCE
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State | AL
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Zip | 35630-2729
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Country | US
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Telephone | 256-275-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 FLORENCE BLVD SUITE F
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City | FLORENCE
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State | AL
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Zip | 35630-2729
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Country | US
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Telephone | 256-275-3535
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTIONER
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Name | TRACY DELANE ADAMS
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Credential | CO
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Telephone | 256-275-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 72
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License Number State | AL
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