Provider Demographics
NPI:1679753446
Name:ADAMS, DEOMA JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:DEOMA
Middle Name:JOSEPH
Last Name:ADAMS
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 1:290 BOWIE RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6712
Mailing Address - Country:US
Mailing Address - Phone:985-493-4782
Mailing Address - Fax:985-449-2548
Practice Address - Street 1:290 BOWIE RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6712
Practice Address - Country:US
Practice Address - Phone:985-493-4782
Practice Address - Fax:985-449-2548
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist