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NPI Code Detail

MEDICARE: MS. KIMBERLY ELLEFSON PTA

MEDICARE: MS. KIMBERLY ELLEFSON 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
1225200000XPhysical Therapy Assistant150-019WI

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 : 1942477898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY ELLEFSON PTA
Provider Business Mailing Address
First Line : 10330 PRAIRIE RIDGE BLVD
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-1947
Country : US
Telephone Number : 262-612-2856
Fax Number : 262-612-2893
Provider Business Practice Location Address
First Line : 10330 PRAIRIE RIDGE BLVD
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-1947
Country : US
Telephone Number : 262-612-2856
Fax Number : 262-612-2893
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2008
Last Update Date : 03/05/2015

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Directions to “ MS. KIMBERLY ELLEFSON PTA” Practice Location

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