Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 11281024 | WI |
NPI | 1396067203 |
---|---|
Provider Name | Elizabeth Carter |
First Address | Stoughton, WI 53589-1857 |
Second Address | Stoughton, WI 53589-1857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2010 |
Last Update Date | 18/02/2010 |