Healthcare Provider Details

I. General information

NPI: 1306154299
Provider Name (Legal Business Name): ELIZABETH I BURCH D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CENTENNIAL CENTRE BLVD
HOBART WI
54155-8989
US

IV. Provider business mailing address

N6135 WOODLAND MEADOWS DR
SHEBOYGAN WI
53083-3347
US

V. Phone/Fax

Practice location:
  • Phone: 920-600-8583
  • Fax:
Mailing address:
  • Phone: 920-207-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11607-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: