Provider Demographics
NPI:1952924219
Name:ADAM, MITCHELL DAVID (DPT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DAVID
Last Name:ADAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N 16TH ST RM 215
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2117
Mailing Address - Country:US
Mailing Address - Phone:414-288-1400
Mailing Address - Fax:414-288-6079
Practice Address - Street 1:604 N 16TH ST
Practice Address - Street 2:CRAMER HALL ROOM 104
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2117
Practice Address - Country:US
Practice Address - Phone:414-288-6122
Practice Address - Fax:414-288-7334
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15651-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist