Provider Demographics
NPI:1003387812
Name:LAW, ADAM DAVID
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVID
Last Name:LAW
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 1:742 ISABEL ST.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065
Mailing Address - Country:US
Mailing Address - Phone:207-357-9411
Mailing Address - Fax:
Practice Address - Street 1:17071 VENTURA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4142
Practice Address - Country:US
Practice Address - Phone:818-232-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist