Provider Demographics
NPI:1205169513
Name:JOHNSON, ADAM SPENCER (MPT)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:SPENCER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1340
Mailing Address - Country:US
Mailing Address - Phone:207-839-5860
Mailing Address - Fax:207-799-9340
Practice Address - Street 1:161 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3623
Practice Address - Country:US
Practice Address - Phone:207-799-8226
Practice Address - Fax:207-799-9340
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist