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General NPI Number Information
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NPI Number | 1083110076
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Entity Type | Individual
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Provider Name | BRIAN KASS PT, DPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 1010 OLIVE AVENUE
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City | FLORENCE
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State | WI
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Zip | 54121
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Country | US
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Telephone | 715-528-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 744 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-3505
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Country | US
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Telephone | 920-445-7226
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Fax | 920-445-7229
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501013364
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11338-024
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License Number State | WI
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