Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 9677 | MN |
Y | 2251S0007X | Physical Therapist - Sports | 31001 | AZ |
NPI | 1134528409 |
---|---|
Provider Name | Adam Halseth |
First Address | Scottsdale, AZ 85255-7441 |
Second Address | Scottsdale, AZ 85255-7441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2014 |
Last Update Date | 18/12/2019 |