Provider Demographics
NPI:1982288940
Name:MCINTYRE, ADAM J I (DPT)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:MCINTYRE
Suffix:I
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 1:6810 BELHURST AVE
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9313
Mailing Address - Country:US
Mailing Address - Phone:616-481-0761
Mailing Address - Fax:
Practice Address - Street 1:3540 FAIRLANES AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1536
Practice Address - Country:US
Practice Address - Phone:616-531-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist