MEDICARE: ELIZABETH V FRUNER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	49804	CA

General Provider Information

NPI Number	:	1073195012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH V FRUNER PTA

Provider Business Mailing Address
First Line	:	905 MAPLE ST
Second Line	:
City	:	HOQUIAM
State	:	WA
Zip	:	98550-2110
Country	:	US
Telephone Number	:	360-917-5253
Fax Number	:

Provider Business Practice Location Address
First Line	:	678 2ND ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6901
Country	:	US
Telephone Number	:	707-938-1096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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