Provider Demographics
NPI:1831529791
Name:PADGETT, ADAM (PTA, CKTP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PADGETT
Suffix:
Gender:M
Credentials:PTA, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9495
Mailing Address - Country:US
Mailing Address - Phone:850-215-8844
Mailing Address - Fax:850-215-6644
Practice Address - Street 1:807 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:FL
Practice Address - Zip Code:32404-9495
Practice Address - Country:US
Practice Address - Phone:850-215-8844
Practice Address - Fax:850-215-6644
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23327225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant