Provider Demographics
NPI:1407481138
Name:CORWIN, ADAM RAY (LMT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RAY
Last Name:CORWIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 E WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5126
Mailing Address - Country:US
Mailing Address - Phone:319-961-9869
Mailing Address - Fax:
Practice Address - Street 1:1940 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1340
Practice Address - Country:US
Practice Address - Phone:319-961-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0013618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist