Provider Demographics
NPI:1982228086
Name:ADAMS, GAIL DIANE
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:DIANE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6700
Mailing Address - Country:US
Mailing Address - Phone:540-589-4973
Mailing Address - Fax:
Practice Address - Street 1:7070 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6700
Practice Address - Country:US
Practice Address - Phone:540-589-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP002894T225100000X
VA2305213136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist