Provider Demographics
NPI:1790268647
Name:ADAMS, THOMAS ALAN (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8553 WESTBERRY LN
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7539
Mailing Address - Country:US
Mailing Address - Phone:815-931-1442
Mailing Address - Fax:
Practice Address - Street 1:18800 SW VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1239
Practice Address - Country:US
Practice Address - Phone:815-931-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer