Basic Information
| Provider Information | |||||||||
| NPI: | 1578537379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT OCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W 8TH AVE | ||||||||
| Address2: | #170 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098384700 | ||||||||
| FaxNumber: | 5098384716 | ||||||||
| Practice Location | |||||||||
| Address1: | 3010 SE BLVD | ||||||||
| Address2: | STE F | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095339003 | ||||||||
| FaxNumber: | 5095339010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00002084 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8335036 | 05 | WA | MEDICAID | 158986 | 01 | L & I | OTHER |