Provider Demographics
NPI:1225335714
Name:AUTRY, ADAM W (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:W
Last Name:AUTRY
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 1:530 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4426
Mailing Address - Country:US
Mailing Address - Phone:910-483-9300
Mailing Address - Fax:910-483-9302
Practice Address - Street 1:1910 N CHURCH ST
Practice Address - Street 2:STE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5632
Practice Address - Country:US
Practice Address - Phone:336-274-7480
Practice Address - Fax:336-274-8903
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist