Provider Demographics
NPI:1962198028
Name:CASBORN, ADAM NELSON JR (PTA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:NELSON
Last Name:CASBORN
Suffix:JR
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 1:3850 RIDGEMONT DR STE C
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2343
Mailing Address - Country:US
Mailing Address - Phone:256-953-2523
Mailing Address - Fax:
Practice Address - Street 1:3850 RIDGEMONT DR STE C
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2343
Practice Address - Country:US
Practice Address - Phone:325-695-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166645225200000X
LAA7495225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant