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General NPI Number Information
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NPI Number | 1487152237
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Entity Type | Individual
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Provider Name | KAREN R EBBERT PTA
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 1365 N PORT WASHINGTON RD
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City | GRAFTON
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State | WI
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Zip | 53024-9333
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Country | US
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Telephone | 262-474-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2426-19
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License Number State | WI
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