Individual
MR. ADAM M WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
206 GLEN ST, SUITE #52, GLENS FALLS, NY 12801-3584
(518) 538-8778
(518) 636-3204
Mailing address
221 MAIN ST, SOUTH GLENS FALLS, NY 12803-5118
(518) 225-5049
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
027046-1
NY
225100000X
Physical Therapist
2305204833
VA
225100000X
Physical Therapist
PT00010625
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223203
DEPARTMENT OF L&I
WA
01
—
2149WI
REGENCE/BLUESHIELD
WA
01
—
2305204833
LICENSE NUMBER
VA
01
—
2639WI
REGENCE/BLUE SHIELD
WA
01
—
6393WI
REGENCE/BLUE SHIELD
WA
01
—
8944992
L&I CRIME VICTIMS
WA
01
—
92527059
AETNA
WA
Enumeration date
09/26/2006
Last updated
04/11/2011
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