John Dusky Adamson Jr., PT

Key facts

NPI

1003005976

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

1373 (SD)

Practice address

26179 Reservation Lane
Ruther Glen, VA 22546-5762

Phone

(804) 258-3950

NPI assigned

Oct 17, 2007

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 25, 2023.

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1003005976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26179 RESERVATION LANE",
            "city": "RUTHER GLEN",
            "state": "VA",
            "postal_code": "225465762",
            "telephone_number": "804-258-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26179 RESERVATION LANE",
            "city": "RUTHER GLEN",
            "state": "VA",
            "postal_code": "225465762",
            "telephone_number": "804-258-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADAMSON",
        "first_name": "JOHN",
        "middle_name": "DUSKY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SD",
            "license": "1373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT-5590",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "2305206712",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Ruther Glen, VA · Physical Therapist in Virginia