Basic Information
| Provider Information | |||||||||
| NPI: | 1427308311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNNIDIS | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 WEIR LN | ||||||||
| Address2: | |||||||||
| City: | LOCUST VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115601631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165091043 | ||||||||
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| Practice Location | |||||||||
| Address1: | 720 LINDSAY LN | ||||||||
| Address2: | |||||||||
| City: | CODY | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824144103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075781970 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 09/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1445 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.