Provider Demographics
NPI:1609326404
Name:PRATHER, ADAM MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:PRATHER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 US HIGHWAY 25 E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2076
Mailing Address - Country:US
Mailing Address - Phone:606-248-1996
Mailing Address - Fax:606-248-1901
Practice Address - Street 1:2835 SOUTH HIGHWAY US 27
Practice Address - Street 2:SUITE 286B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-248-1996
Practice Address - Fax:606-248-1901
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007006OtherPT LICENSE