Provider Demographics
NPI:1588323778
Name:TRUSCOTT, ADAM L (PTA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:L
Last Name:TRUSCOTT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S HARBOR PARK CT
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7772
Mailing Address - Country:US
Mailing Address - Phone:208-512-1009
Mailing Address - Fax:
Practice Address - Street 1:405 7TH STREET
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:ID
Practice Address - Zip Code:83867
Practice Address - Country:US
Practice Address - Phone:208-556-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-3041225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant