Provider Demographics
NPI:1174377139
Name:MESSINA, ADAM RUSSELL (PT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:RUSSELL
Last Name:MESSINA
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 1:16 SCHUMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546
Mailing Address - Country:US
Mailing Address - Phone:914-488-5440
Mailing Address - Fax:914-488-5441
Practice Address - Street 1:16 SCHUMAN ROAD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:NY
Practice Address - Zip Code:10546
Practice Address - Country:US
Practice Address - Phone:914-488-5440
Practice Address - Fax:914-488-5441
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist