Provider Demographics
NPI:1891007324
Name:DEIMLING, ADAM JOSEPH (MED, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JOSEPH
Last Name:DEIMLING
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N WOODLAND BLVD
Mailing Address - Street 2:UNIT 8317
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32723-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3510
Practice Address - Country:US
Practice Address - Phone:386-822-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL27232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer