Provider Demographics
NPI:1356687586
Name:ADAMS, TERESA LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:390 NW GADWALL WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-3313
Mailing Address - Country:US
Mailing Address - Phone:850-929-6949
Mailing Address - Fax:850-973-6536
Practice Address - Street 1:456 W BASE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2061
Practice Address - Country:US
Practice Address - Phone:850-973-2187
Practice Address - Fax:850-973-6536
Is Sole Proprietor?:No
Enumeration Date:2012-12-16
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23660225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant