Provider Demographics
NPI:1578969341
Name:ADERHOLD-CRASS, KAREN A (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:ADERHOLD-CRASS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:ADERHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:900 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-6944
Mailing Address - Country:US
Mailing Address - Phone:920-787-6900
Mailing Address - Fax:920-787-6903
Practice Address - Street 1:900 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-6944
Practice Address - Country:US
Practice Address - Phone:920-787-6900
Practice Address - Fax:920-787-6903
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12875-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist