Provider Demographics
NPI:1225107022
Name:DAWSON, ADAM MARSHALL (PT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MARSHALL
Last Name:DAWSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 PATCON WAY
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026
Mailing Address - Country:US
Mailing Address - Phone:614-329-9757
Mailing Address - Fax:
Practice Address - Street 1:1680 WATERMARK DR
Practice Address - Street 2:SUITE 200A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1034
Practice Address - Country:US
Practice Address - Phone:614-358-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-9997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2552867Medicaid
OHPO30BWC130305552OtherWORKER'S COMPENSATION
OH0560284Medicare Oscar/Certification
OH2552867Medicaid