Provider Demographics
NPI:1699530311
Name:DIAMOND, ADAM (DPT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2763 KISSIMMEE BAY CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3946
Mailing Address - Country:US
Mailing Address - Phone:606-875-3260
Mailing Address - Fax:
Practice Address - Street 1:2763 KISSIMMEE BAY CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3946
Practice Address - Country:US
Practice Address - Phone:606-875-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007100225100000X
MN12136225100000X
FL34454225100000X
KY10782255A2300X
MN33782255A2300X
FL55482255A2300X
VA2305216296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer