Provider Demographics
NPI:1164826624
Name:REEL, ADAM (ATC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:REEL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 OLD HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-9631
Mailing Address - Country:US
Mailing Address - Phone:317-919-9821
Mailing Address - Fax:
Practice Address - Street 1:1820 PINE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3750
Practice Address - Country:US
Practice Address - Phone:608-785-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0043672255A2300X
WI1764-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer