Provider Demographics
NPI:1497746457
Name:ADAME, JENNIFER A (MPT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:A
Last Name:ADAME
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-5267
Mailing Address - Country:US
Mailing Address - Phone:559-222-7497
Mailing Address - Fax:559-224-9310
Practice Address - Street 1:4080 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5267
Practice Address - Country:US
Practice Address - Phone:559-222-7497
Practice Address - Fax:559-224-9310
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT258472Medicare PIN