Provider Demographics
NPI:1457650830
Name:GASS, CHRIS MICHAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:MICHAEL
Last Name:GASS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 UTAH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:IA
Mailing Address - Zip Code:52755-9798
Mailing Address - Country:US
Mailing Address - Phone:515-210-6257
Mailing Address - Fax:
Practice Address - Street 1:5335 UTAH AVE SE
Practice Address - Street 2:64 DANBURY ROAD
Practice Address - City:LONE TREE
Practice Address - State:IA
Practice Address - Zip Code:52755-9798
Practice Address - Country:US
Practice Address - Phone:800-278-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2599225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant