Provider Demographics
NPI:1598069890
Name:ADAMS, ANNETTE ASHLEY (CMT)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ASHLEY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 LYN PARK LN N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3329
Mailing Address - Country:US
Mailing Address - Phone:612-232-1740
Mailing Address - Fax:
Practice Address - Street 1:3647 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2919
Practice Address - Country:US
Practice Address - Phone:612-728-0223
Practice Address - Fax:612-728-0377
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist