Provider Demographics
NPI:1487185385
Name:HOSTASCH, CLAUS
Entity Type:Individual
Prefix:
First Name:CLAUS
Middle Name:
Last Name:HOSTASCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 WILLIAMSBURG WAY
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1617
Mailing Address - Country:US
Mailing Address - Phone:608-770-2279
Mailing Address - Fax:
Practice Address - Street 1:5728 WILLIAMSBURG WAY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1617
Practice Address - Country:US
Practice Address - Phone:608-770-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2319-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist