Provider Demographics
NPI:1770248510
Name:ADAMS, AUBREY MARISA
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:MARISA
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 1:13 AGGIE VLG APT E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2626
Mailing Address - Country:US
Mailing Address - Phone:916-718-1222
Mailing Address - Fax:
Practice Address - Street 1:13 AGGIE VLG APT E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2626
Practice Address - Country:US
Practice Address - Phone:916-718-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7047225100000X
UT11795618-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist