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NPI Code Detail

MEDICARE: ERIC A GULBRONSON PT

MEDICARE: ERIC A GULBRONSON 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
1225100000XPhysical Therapist3104WI

General Provider Information

NPI Number : 1720294085
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC A GULBRONSON PT
Provider Business Mailing Address
First Line : 900 E DIVISION ST
Second Line :
City : WAUTOMA
State : WI
Zip : 54982-6944
Country : US
Telephone Number : 920-787-6900
Fax Number :
Provider Business Practice Location Address
First Line : 900 E DIVISION ST
Second Line :
City : WAUTOMA
State : WI
Zip : 54982-6944
Country : US
Telephone Number : 920-787-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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Directions to “ ERIC A GULBRONSON PT” Practice Location

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