Provider Demographics
NPI:1699817619
Name:TOOLE, ADAM JAMES (PTA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JAMES
Last Name:TOOLE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:ADAM
Other - Middle Name:JAMES
Other - Last Name:TOOLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:40 FIRETHORN LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9227
Mailing Address - Country:US
Mailing Address - Phone:386-447-4488
Mailing Address - Fax:
Practice Address - Street 1:1275 W GRANADA BLVD
Practice Address - Street 2:SUITE 4B2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8259
Practice Address - Country:US
Practice Address - Phone:386-615-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20619225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant