Provider Demographics
NPI:1558241232
Name:STURDIVANT, ADRIAN DEVIN
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:DEVIN
Last Name:STURDIVANT
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 1:102A BURR ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-3255
Mailing Address - Country:US
Mailing Address - Phone:704-465-4568
Mailing Address - Fax:
Practice Address - Street 1:311 W PHIFER ST
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1322
Practice Address - Country:US
Practice Address - Phone:704-624-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8695225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant