MEDICARE: ELIZABETH LOUISE GARRETT PT

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	174400000X	Specialist	AZ696	AZ

General Provider Information

NPI Number	:	1548596729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LOUISE GARRETT PT

Provider Business Mailing Address
First Line	:	2918 POST RD
Second Line	:	SUITE B
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-6417
Country	:	US
Telephone Number	:	715-295-9820
Fax Number	:	715-295-9821

Provider Business Practice Location Address
First Line	:	5219 E VIA BUENA VISTA
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253
Country	:	US
Telephone Number	:	715-295-9820
Fax Number	:	715-295-9821

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

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	06/18/2015

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