Basic Information
| Provider Information | |||||||||
| NPI: | 1952924219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAM | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 604 N 16TH ST RM 215 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532332117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142881400 | ||||||||
| FaxNumber: | 4142886079 | ||||||||
| Practice Location | |||||||||
| Address1: | 604 N 16TH ST | ||||||||
| Address2: | CRAMER HALL ROOM 104 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532332117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142886122 | ||||||||
| FaxNumber: | 4142887334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2020 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15651-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.