Provider Demographics
NPI:1194063826
Name:HANES, ADAM ARTHUR (MPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:ARTHUR
Last Name:HANES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-1828
Mailing Address - Country:US
Mailing Address - Phone:309-357-5470
Mailing Address - Fax:309-357-5943
Practice Address - Street 1:486 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-1828
Practice Address - Country:US
Practice Address - Phone:309-357-5470
Practice Address - Fax:309-357-5943
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist