MEDICARE: ADAM KEAPPROTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3160-19	WI

General Provider Information

NPI Number	:	1700512316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM KEAPPROTH

Provider Business Mailing Address
First Line	:	904 EMERY ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-4183
Country	:	US
Telephone Number	:	218-515-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 RIVER AVE S
Second Line	:
City	:	PRAIRIE FARM
State	:	WI
Zip	:	54762-9791
Country	:	US
Telephone Number	:	715-455-1178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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Directions to “ ADAM KEAPPROTH ” Practice Location

Language	Start Address	Practice Location

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