Provider Demographics
NPI:1568622306
Name:ADAMS, DEBRA (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 TEN ROD RD
Mailing Address - Street 2:BOX 4
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4236
Mailing Address - Country:US
Mailing Address - Phone:401-295-9767
Mailing Address - Fax:401-295-0230
Practice Address - Street 1:610 TEN ROD RD
Practice Address - Street 2:BOX 4
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4236
Practice Address - Country:US
Practice Address - Phone:401-295-9767
Practice Address - Fax:401-295-0230
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI78737OtherBLUE CROSS OF RI NON PAR #
RI6409395OtherUNITED HEALTH NON PAR #