Provider Demographics
NPI:1467008136
Name:WEISENBORN, ADAM C (OTR/L)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:WEISENBORN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ENTERPRISE PKWY STE 900
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6250
Mailing Address - Country:US
Mailing Address - Phone:757-827-2480
Mailing Address - Fax:757-827-2566
Practice Address - Street 1:901 ENTERPRISE PKWY STE 900
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6250
Practice Address - Country:US
Practice Address - Phone:757-827-2480
Practice Address - Fax:757-827-2566
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-008241225XH1200X
VA0119008241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand