Basic Information
| Provider Information | |||||||||
| NPI: | 1124782214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALLER | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 BREWSTER DR APT 7 | ||||||||
| Address2: | |||||||||
| City: | LAKE MILLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535511783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083854303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7901 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531542010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143468000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.