Provider Demographics
NPI:1699086405
Name:WADAMS, VALERIE GRACE (PTA)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:GRACE
Last Name:WADAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7476 SOUTH PEARL ST RD
Mailing Address - Street 2:
Mailing Address - City:OAKFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14125-9782
Mailing Address - Country:US
Mailing Address - Phone:585-948-9005
Mailing Address - Fax:
Practice Address - Street 1:7476 SOUTH PEARL ST. RD.
Practice Address - Street 2:
Practice Address - City:OAKFIELD
Practice Address - State:NY
Practice Address - Zip Code:14125-9782
Practice Address - Country:US
Practice Address - Phone:585-948-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009501-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant