Provider Demographics
NPI:1932184025
Name:LARAWAY, ADAM CULVER (PT, MSPT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:CULVER
Last Name:LARAWAY
Suffix:
Gender:M
Credentials:PT, MSPT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:25050 PEACHLAND AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5770
Mailing Address - Country:US
Mailing Address - Phone:661-255-4205
Mailing Address - Fax:661-255-4206
Practice Address - Street 1:25050 PEACHLAND AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5770
Practice Address - Country:US
Practice Address - Phone:661-255-4205
Practice Address - Fax:661-255-4206
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT256632251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25663DMedicare PIN