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NPI Code Detail

MEDICARE: MRS. ROSALYN ELIZABETH PASSEHL PT

MEDICARE: MRS. ROSALYN ELIZABETH PASSEHL PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1248-024WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11248-024OTHERWISTATE LICENSE

General Provider Information

NPI Number : 1356355549
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROSALYN ELIZABETH PASSEHL PT
Provider Business Mailing Address
First Line : 2667 PICKETT ST
Second Line :
City : PLYMOUTH
State : WI
Zip : 53073-5017
Country : US
Telephone Number : 920-893-6360
Fax Number :
Provider Business Practice Location Address
First Line : 1125 N 13TH ST
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-3281
Country : US
Telephone Number : 920-208-9648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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