Provider Demographics
NPI:1184405839
Name:ADAM, WESTON SCOTT
Entity type:Individual
Prefix:MR
First Name:WESTON
Middle Name:SCOTT
Last Name:ADAM
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 1:24700 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:ASTOR
Mailing Address - State:FL
Mailing Address - Zip Code:32102-3521
Mailing Address - Country:US
Mailing Address - Phone:352-391-2889
Mailing Address - Fax:
Practice Address - Street 1:24700 DEXTER RD
Practice Address - Street 2:
Practice Address - City:ASTOR
Practice Address - State:FL
Practice Address - Zip Code:32102-3521
Practice Address - Country:US
Practice Address - Phone:352-391-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer