Provider Demographics
NPI:1891390217
Name:TRISLER, ADAM (LMT, CHHP, PAC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:TRISLER
Suffix:
Gender:M
Credentials:LMT, CHHP, PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30966 RIVERBEND CIR APT 8
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-7635
Mailing Address - Country:US
Mailing Address - Phone:574-612-4527
Mailing Address - Fax:
Practice Address - Street 1:57465 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9799
Practice Address - Country:US
Practice Address - Phone:574-612-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014033APP20225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist