Provider Demographics
NPI:1639259500
Name:ADSIT, VICKI A (PT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:A
Last Name:ADSIT
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 1:1203 KIOWA DR E
Mailing Address - Street 2:
Mailing Address - City:LAKE KIOWA
Mailing Address - State:TX
Mailing Address - Zip Code:76240-9581
Mailing Address - Country:US
Mailing Address - Phone:940-612-2486
Mailing Address - Fax:
Practice Address - Street 1:1203 KIOWA DR E
Practice Address - Street 2:
Practice Address - City:LAKE KIOWA
Practice Address - State:TX
Practice Address - Zip Code:76240-9581
Practice Address - Country:US
Practice Address - Phone:940-612-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist