Basic Information
| Provider Information | |||||||||
| NPI: | 1558663682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GESKE | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3117 SHORE DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | MARINETTE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541434294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157325211 | ||||||||
| FaxNumber: | 7157320628 | ||||||||
| Practice Location | |||||||||
| Address1: | 3117 SHORE DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | MARINETTE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541434294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157325211 | ||||||||
| FaxNumber: | 7157320628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2010 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11489-024 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.