Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1373 | SD |
NPI | 1003005976 |
---|---|
Provider Name | John Dusky Adamson JR. |
First Address | Rapid City, SD 57701-5762 |
Second Address | Rapid City, SD 57701-5762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/10/2007 |