Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1144788381 |
---|---|
Provider Name | Elizabeth Udovich |
First Address | Waukesha, WI 53188-8029 |
Second Address | Brookfield, WI 53045-5197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 06/03/2019 |