Provider Demographics
NPI:1962876284
Name:ADAM, ANDREW JAMES (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:ADAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:51385 SW OLD PORTLAND RD
Practice Address - Street 2:SUITE E
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-4061
Practice Address - Country:US
Practice Address - Phone:503-543-7768
Practice Address - Fax:503-543-7772
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist