Provider Demographics
NPI:1366701187
Name:DUNCAN, ADAM NICHOLAS
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:NICHOLAS
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 94
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-9208
Mailing Address - Country:US
Mailing Address - Phone:304-738-8929
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 94
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-9208
Practice Address - Country:US
Practice Address - Phone:240-727-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3226225200000X
WV001753225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant