Provider Demographics
NPI:1811964075
Name:ADLER, PHILLIP J (PHD, AT, ATC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:J
Last Name:ADLER
Suffix:
Gender:M
Credentials:PHD, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 HAWTHORNE LNDG NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-1859
Mailing Address - Country:US
Mailing Address - Phone:616-283-0701
Mailing Address - Fax:
Practice Address - Street 1:1577 HAWTHORNE LNDG NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-1859
Practice Address - Country:US
Practice Address - Phone:616-283-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010000872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer