Provider Demographics
NPI:1568560993
Name:VAMSTAD, BRAD A (MA, LAT)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:A
Last Name:VAMSTAD
Suffix:
Gender:M
Credentials:MA, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 PROFESSIONAL DR APT 205
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1180
Mailing Address - Country:US
Mailing Address - Phone:608-930-7766
Mailing Address - Fax:
Practice Address - Street 1:800 COMPASSION WAY
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1956
Practice Address - Country:US
Practice Address - Phone:608-930-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI450-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer