Provider Demographics
NPI:1972340388
Name:TEDFORD, ADAM GARRETT
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:GARRETT
Last Name:TEDFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 SAMS PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8386
Mailing Address - Country:US
Mailing Address - Phone:870-897-8991
Mailing Address - Fax:
Practice Address - Street 1:1502 HIGHWAY 367
Practice Address - Street 2:
Practice Address - City:TUCKERMAN
Practice Address - State:AR
Practice Address - Zip Code:72473
Practice Address - Country:US
Practice Address - Phone:870-522-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant