MEDICARE: ELIZABETH ANNE PEDI DPT

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	225100000X	Physical Therapist	15234-24	WI

General Provider Information

NPI Number	:	1417808692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE PEDI DPT

Provider Business Mailing Address
First Line	:	1626 N PROSPECT AVE APT 1708
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2435
Country	:	US
Telephone Number	:	847-380-0851
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 N 16TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2117
Country	:	US
Telephone Number	:	847-380-0851
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “ ELIZABETH ANNE PEDI DPT” Practice Location

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