Provider Demographics
NPI:1114606191
Name:FABRICIUS, ADAM JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JAMES
Last Name:FABRICIUS
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 1:194 EVERWILD LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2040
Mailing Address - Country:US
Mailing Address - Phone:585-278-8273
Mailing Address - Fax:
Practice Address - Street 1:194 EVERWILD LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2040
Practice Address - Country:US
Practice Address - Phone:585-278-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist