Provider Demographics
NPI:1720400336
Name:SCHETSELAAR, ADAM (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SCHETSELAAR
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 1:4102 S MERIDIAN
Mailing Address - Street 2:STE E5
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5962
Mailing Address - Country:US
Mailing Address - Phone:253-217-0832
Mailing Address - Fax:
Practice Address - Street 1:4102 S MERIDIAN
Practice Address - Street 2:STE E5
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5962
Practice Address - Country:US
Practice Address - Phone:253-217-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60391158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist