Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | P13724 | NC |
NPI | 1073878864 |
---|---|
Provider Name | Mrs. Jessica Humbach Adamczak |
First Address | Matthews, NC 28105-2457 |
Second Address | Charlotte, NC 28277-6691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 05/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q40350A | MEDICARE PTAN (01) | NC |