Provider Demographics
NPI:1548314008
Name:MAIN, ADAM R (PTA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:R
Last Name:MAIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:2445 140TH AVE NE
Mailing Address - Street 2:SUITE B105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-644-6328
Mailing Address - Fax:425-644-6295
Practice Address - Street 1:21907 64TH AVE W
Practice Address - Street 2:SUITE #110
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043
Practice Address - Country:US
Practice Address - Phone:425-673-5220
Practice Address - Fax:425-673-1597
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2009-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPL 60033988225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant