Healthcare Provider Details

I. General information

NPI: 1427621317
Provider Name (Legal Business Name): ELIZABETH JEAN TRUDELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 N MEADE ST
APPLETON WI
54911-1509
US

IV. Provider business mailing address

1218 PARTRIDGE RD
DE PERE WI
54115-9652
US

V. Phone/Fax

Practice location:
  • Phone: 920-993-6800
  • Fax:
Mailing address:
  • Phone: 920-944-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17654-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3196-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: