Provider Demographics
NPI:1225755960
Name:DEPEW, ADAM JAMES JOSEPH (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JAMES JOSEPH
Last Name:DEPEW
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:208 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-6271
Mailing Address - Country:US
Mailing Address - Phone:256-656-3297
Mailing Address - Fax:
Practice Address - Street 1:301 SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-1911
Practice Address - Country:US
Practice Address - Phone:256-824-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer