Provider Demographics
NPI:1407807597
Name:STICKLEY, ADAM W (PT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:W
Last Name:STICKLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:970 BRANCHVIEW RD, NE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2234
Mailing Address - Country:US
Mailing Address - Phone:704-782-1322
Mailing Address - Fax:704-786-4752
Practice Address - Street 1:970 BRANCHVIEW DR NE
Practice Address - Street 2:SUITE 160
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2208
Practice Address - Country:US
Practice Address - Phone:704-782-1322
Practice Address - Fax:704-786-4752
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2502812Medicare PIN