Provider Demographics
NPI:1609836576
Name:ADAMS, JACOB A (PT)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:M
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:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-0175
Mailing Address - Country:US
Mailing Address - Phone:205-661-0810
Mailing Address - Fax:205-661-9841
Practice Address - Street 1:4901 DEERFOOT PKWY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2697
Practice Address - Country:US
Practice Address - Phone:205-661-0810
Practice Address - Fax:205-661-9841
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7688696OtherAETNA
AL631156852001OtherTRICARE
ALP00216937Medicare UPIN