Basic Information
| Provider Information | |||||||||
| NPI: | 1457650830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASS | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5335 UTAH AVE SE | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527559798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152106257 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5335 UTAH AVE SE | ||||||||
| Address2: | 64 DANBURY ROAD | ||||||||
| City: | LONE TREE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527559798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002780332 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2011 | ||||||||
| LastUpdateDate: | 03/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2599 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.