Provider Demographics
NPI:1982183075
Name:KING, ADAM ROBERT
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:ROBERT
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087-0456
Mailing Address - Country:US
Mailing Address - Phone:207-247-3216
Mailing Address - Fax:207-247-3217
Practice Address - Street 1:392 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087
Practice Address - Country:US
Practice Address - Phone:207-347-3216
Practice Address - Fax:207-347-3217
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist