Healthcare Provider Details

I. General information

NPI: 1750121489
Provider Name (Legal Business Name): ALLI R SPITZER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 WAUBE LN
GREEN BAY WI
54304-5521
US

IV. Provider business mailing address

840 ELEMENT WAY UNIT 414
GREEN BAY WI
54304-4640
US

V. Phone/Fax

Practice location:
  • Phone: 920-548-9500
  • Fax:
Mailing address:
  • Phone: 920-255-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16771-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: