Provider Demographics
NPI:1326472192
Name:EISEMAN, ADAM DUANE (DPT)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DUANE
Last Name:EISEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 S OLD 11
Mailing Address - Street 2:
Mailing Address - City:ORFORDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53576-9610
Mailing Address - Country:US
Mailing Address - Phone:608-214-8706
Mailing Address - Fax:
Practice Address - Street 1:2004 E RIVERSIDE BLVD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4856
Practice Address - Country:US
Practice Address - Phone:608-214-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12479-24225100000X
IL070023502225100000X
IA005279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist