Provider Demographics
NPI:1407243660
Name:POWERS, ADAM L (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:L
Last Name:POWERS
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:PO BOX 242278
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2278
Mailing Address - Country:US
Mailing Address - Phone:334-625-5795
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:747 HIGHWAY 71 W # B200
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4096
Practice Address - Country:US
Practice Address - Phone:512-920-6512
Practice Address - Fax:678-384-3318
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29688225100000X
GAPT012064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0RQ1OtherFLORIDA BLUE
FLIE139ZMedicare PIN