Provider Demographics
NPI:1134781115
Name:ADAMS, WILSON SCOTT (PTA)
Entity type:Individual
Prefix:MR
First Name:WILSON
Middle Name:SCOTT
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-7814
Mailing Address - Country:US
Mailing Address - Phone:864-884-6685
Mailing Address - Fax:
Practice Address - Street 1:205 BUD NALLEY DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3578
Practice Address - Country:US
Practice Address - Phone:864-307-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1450225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant