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General NPI Number Information
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NPI Number | 1205901352
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Entity Type | Individual
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Provider Name | MARCO ANTONIO ADAME' JR. DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 W GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91202
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Country | US
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Telephone | 818-637-2127
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 W SAN BERNARDINO RD APT 262
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City | COVINA
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State | CA
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Zip | 91722-4406
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Country | US
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Telephone |
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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 | 33076
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License Number State | CA
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