Provider Demographics
NPI:1376252809
Name:ADAMS, MACY MALYN
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:MALYN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18349 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKER
Mailing Address - State:FL
Mailing Address - Zip Code:32622-3030
Mailing Address - Country:US
Mailing Address - Phone:352-538-7044
Mailing Address - Fax:
Practice Address - Street 1:4820 NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2249
Practice Address - Country:US
Practice Address - Phone:352-373-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist