Provider Demographics
NPI:1598470874
Name:GASS, WILLIAM ELI
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELI
Last Name:GASS
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 1:143 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:MOORESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37811-5323
Mailing Address - Country:US
Mailing Address - Phone:423-923-4737
Mailing Address - Fax:
Practice Address - Street 1:143 SHELBY RD
Practice Address - Street 2:
Practice Address - City:MOORESBURG
Practice Address - State:TN
Practice Address - Zip Code:37811-5323
Practice Address - Country:US
Practice Address - Phone:423-923-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program