=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215298922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALZADA E OEMIG P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2012
-----------------------------------------------------
Last Update Date | 10/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 PINE ST
-----------------------------------------------------
City | STANLEY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54768-1297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-644-6133
-----------------------------------------------------
Fax | 715-644-6221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13055 270TH ST
-----------------------------------------------------
City | CADOTT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54727-4629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-313-0385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 11586-24
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------