Provider Demographics
NPI:1912672650
Name:ADAMS, CLARISE
Entity Type:Individual
Prefix:
First Name:CLARISE
Middle Name:
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 1:144 WHITE TAIL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-2876
Mailing Address - Country:US
Mailing Address - Phone:540-624-3090
Mailing Address - Fax:
Practice Address - Street 1:144 WHITE TAIL LN
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-2876
Practice Address - Country:US
Practice Address - Phone:540-624-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant