Provider Demographics
NPI:1558599332
Name:BRILL, ADAM J (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:J
Last Name:BRILL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4963
Mailing Address - Country:US
Mailing Address - Phone:920-451-5559
Mailing Address - Fax:920-451-5664
Practice Address - Street 1:2640 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4963
Practice Address - Country:US
Practice Address - Phone:920-451-5559
Practice Address - Fax:920-451-5664
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI925-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer