Provider Demographics
NPI:1114379971
Name:ROONEY, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ROONEY
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 1:14110 NE 179TH ST APT 21
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6836
Mailing Address - Country:US
Mailing Address - Phone:425-444-9897
Mailing Address - Fax:
Practice Address - Street 1:14110 NE 179TH ST APT 21
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6836
Practice Address - Country:US
Practice Address - Phone:425-444-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60320419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist