Provider Demographics
NPI:1043429111
Name:TYSON, ADAM RICHARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:RICHARD
Last Name:TYSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03256-0070
Mailing Address - Country:US
Mailing Address - Phone:603-677-3400
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST.
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03256-0070
Practice Address - Country:US
Practice Address - Phone:603-677-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer