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General NPI Number Information
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NPI Number | 1457956807
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Entity Type | Individual
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Provider Name | JUSTIN ADAMS
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Gender | Male
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 29667 WENTWORTH ST
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City | LIVONIA
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State | MI
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Zip | 48154-6231
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Country | US
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Telephone | 734-261-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 7116 MAPLELAWN DR
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City | YPSILANTI
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State | MI
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Zip | 48197-1764
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Country | US
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Telephone | 734-347-3800
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502005665
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License Number State | MI
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