Ethan Cole Adams, DPT, PT
Individual provider Active NPI Physical Therapist · Louisville, KY
NPI 1174093090 · NPPES record last updated Dec 4, 2018
Key facts
- NPI
- 1174093090
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 007411 (KY)
- Practice address
- 1800 Bluegrass Ave
Louisville, KY 40215-1130 - Phone
- (502) 361-2301
- NPI assigned
- Dec 4, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231012000828 | TN | Practitioner - Physical Therapist in Private Practice | 7315287083 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007411 | KY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Functional Pathways Preferred of Tennessee LLC | Physical Therapist | Current |
Accepting new patients |
| Privia Medical Group Tennessee LLC | Current |
Accepting new patients | |
| Privia Medical Group Tennessee LLC | Current |
Accepting new patients |
Locations
317 Seven Springs Way
Ste 101
Brentwood, TN 37027
Phone (615) 309-2636
10133 Sherrill Blvd
Ste 200
Knoxville, TN 37932
Phone (865) 392-2847
1009 N Locust Ave
Lawrenceburg, TN 38464
Phone (931) 244-7181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 007411 | KY | Yes |
Addresses
Primary practice location
1800 Bluegrass Ave
Louisville, KY 40215-1130
Mailing address
1800 Bluegrass Ave
Louisville, KY 40215-1130
Phone (502) 361-2301
Other providers in Louisville, KY
- Cynthia R Adams
- Davon Dejoun Adams
- Elan Theleah Adams
- Elizabeth Lowry Adams
- Erica Adams
- Glenda Marie Adams
- Haley Adams
- Heather Marie Adams
- James P Adams
- Jan Adams
All providers in Louisville, KY · Physical Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.