Basic Information
| Provider Information | |||||||||
| NPI: | 1134704653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMSON | ||||||||
| FirstName: | AUSTIN | ||||||||
| MiddleName: | MITCHELL JENKIN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20200 POPLAR CREEK PKWY UNIT 408S | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530452161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492308547 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2455 N 124TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530054630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627829326 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2021 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.