Provider Demographics
NPI:1144287905
Name:EUBANKS, ADAM W (PT)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:W
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WEXFORD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9214
Mailing Address - Country:US
Mailing Address - Phone:724-940-2323
Mailing Address - Fax:724-940-2340
Practice Address - Street 1:1013 WEXFORD PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9214
Practice Address - Country:US
Practice Address - Phone:724-940-2323
Practice Address - Fax:724-940-2340
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012521L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177124OtherMEDICARE HGS ADMINISTRATO
PA03182100OtherCAPITAL BLUE CROSS
PA18444OtherHEALTH AMERICA
PACK4276OtherPALMETTO GBA RR MEDICARE
PA0068377000OtherAMERIHEALTH UNDER IBC
PA332313OtherHIGHMARK BLUE SHIELD
PA0068377000OtherAMERIHEALTH UNDER IBC