Provider Demographics
NPI:1902396856
Name:ADAMS, JAMES ERVIN (DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERVIN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 FORUM DR STE 13
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7943
Mailing Address - Country:US
Mailing Address - Phone:803-509-6880
Mailing Address - Fax:803-509-6881
Practice Address - Street 1:130 FORUM DR STE 13
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229
Practice Address - Country:US
Practice Address - Phone:803-509-6880
Practice Address - Fax:803-509-6881
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist