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NPI Code Detail

MEDICARE: MRS. ELIZABETH ANNE THREASHER PT, DPT, WCC

MEDICARE: MRS. ELIZABETH ANNE THREASHER PT, DPT, WCC
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
1225100000XPhysical Therapist070.016411IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669776290
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH ANNE THREASHER PT, DPT, WCC
Provider Business Mailing Address
First Line : 630 NORTH FOURTH SREET
Second Line : UNIT 808
City : MILWAUKEE
State : WI
Zip : 53203
Country : US
Telephone Number : 414-810-0127
Fax Number :
Provider Business Practice Location Address
First Line : 1616 W BENDER RD
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3802
Country : US
Telephone Number : 414-228-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2010
Last Update Date : 11/05/2013

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