Healthcare Provider Details

I. General information

NPI: 1174747208
Provider Name (Legal Business Name): DEANNA ELLIOTT AUSSPRUNG PT, LAT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/16/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 JUNCTION RD
MADISON WI
53717-2613
US

IV. Provider business mailing address

4834 MORRIS CT
WAUNAKEE WI
53597-9163
US

V. Phone/Fax

Practice location:
  • Phone: 608-658-5352
  • Fax: 888-965-4018
Mailing address:
  • Phone: 608-658-5352
  • Fax: 888-965-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2580-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number45039
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: