Provider Demographics
NPI:1679084800
Name:ADIKI, SAM (PTA)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:ADIKI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4452
Mailing Address - Country:US
Mailing Address - Phone:812-456-8094
Mailing Address - Fax:
Practice Address - Street 1:4120 WOODED ACRE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2938
Practice Address - Country:US
Practice Address - Phone:502-243-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-15
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03721225200000X
FL29785225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty