Healthcare Provider Details

I. General information

NPI: 1992621403
Provider Name (Legal Business Name): ELLEN MARIE BARANOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W DREXEL AVE STE 150
OAK CREEK WI
53154-1918
US

IV. Provider business mailing address

8601 W LAKE POINTE DR
FRANKLIN WI
53132-8579
US

V. Phone/Fax

Practice location:
  • Phone: 414-563-1045
  • Fax:
Mailing address:
  • Phone: 414-708-5275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17803-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: