Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 12333-24 | WI |
NPI | 1003237850 |
---|---|
Provider Name | Ryan Adams |
First Address | Madison, WI 53704-5543 |
Second Address | Lake Geneva, WI 53147-2655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2013 |
Last Update Date | 20/12/2013 |