Provider Demographics
NPI:1184060311
Name:VANZILE, ADAM W (DPT)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:W
Last Name:VANZILE
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 1:1316 MINNICH RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-2052
Mailing Address - Country:US
Mailing Address - Phone:260-748-4864
Mailing Address - Fax:260-749-5960
Practice Address - Street 1:1316 MINNICH RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2052
Practice Address - Country:US
Practice Address - Phone:260-748-4864
Practice Address - Fax:260-749-5960
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010797A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist