Provider Demographics
NPI:1710279153
Name:WIRTZ, ADAM D (PT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:WIRTZ
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9120
Mailing Address - Country:US
Mailing Address - Phone:715-445-2300
Mailing Address - Fax:715-445-2765
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9120
Practice Address - Country:US
Practice Address - Phone:715-445-2300
Practice Address - Fax:715-445-2765
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist