Active NPI
Adam C Marshall, PTA
- Physical Therapy Assistant
- Horn Lake, MS
National Provider Identifier
1053787804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5967
- Practice address
- 4755 Winesap Dr
Horn Lake, MS 38637-7276 - Phone
- (662) 671-5446
- NPI assigned
- Aug 17, 2015
- Last updated
- Aug 17, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5967 | TN | Primary |
Addresses
Primary practice location
4755 Winesap Dr
Horn Lake, MS 38637-7276
Mailing address
4755 Winesap Dr
Horn Lake, MS 38637-7276
Phone (662) 671-5446
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5967 | TN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439769600000",
"number": "1053787804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4755 WINESAP DR",
"city": "HORN LAKE",
"state": "MS",
"postal_code": "386377276",
"telephone_number": "662-671-5446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4755 WINESAP DR",
"city": "HORN LAKE",
"state": "MS",
"postal_code": "386377276",
"telephone_number": "662-671-5446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "ADAM",
"middle_name": "C",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-17",
"last_updated": "2015-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "5967",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Horn Lake, MS
- Bradley Thomas Loeffel, PHARMD
- Terrance Franklin Long, RPH
- Loved Ones Home Care LLC
- Lsa Pediatric Therapy
- Jessica Lucovich, DDS
- John Barrett Martindale, PHARM.D.
- Justin Mathis, PHARM.D
- William P McAlexander, DMD
- McKenzie Alexandra McClanahan, DPT
- Memphis Emergency Specialists PC (Southern Family Medical Clinic)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.