Healthcare Provider Details

I. General information

NPI: 1649636614
Provider Name (Legal Business Name): ADAM S HASS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 RICHARD DR
EAU CLAIRE WI
54701-6242
US

IV. Provider business mailing address

14356 43RD AVE
CHIPPEWA FALLS WI
54729-8836
US

V. Phone/Fax

Practice location:
  • Phone: 715-834-5850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1761-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: