Healthcare Provider Details

I. General information

NPI: 1871321430
Provider Name (Legal Business Name): ELI LOUIS COMBS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N 12TH ST STE 1100
MILWAUKEE WI
53233-1305
US

IV. Provider business mailing address

270 E HIGHLAND AVE APT 812
MILWAUKEE WI
53202-6606
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-7776
  • Fax:
Mailing address:
  • Phone: 970-314-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16867
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: