Provider Demographics
NPI:1518571447
Name:ATTEBERRY, ADAM CLIFFORD (CMT # 75840)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:CLIFFORD
Last Name:ATTEBERRY
Suffix:
Gender:M
Credentials:CMT # 75840
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 NEW YORK AVE APT 1201
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7301
Mailing Address - Country:US
Mailing Address - Phone:916-473-3733
Mailing Address - Fax:
Practice Address - Street 1:8850 AUBURN FOLSOM RD STE H
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6525
Practice Address - Country:US
Practice Address - Phone:916-473-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75840225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty