Basic Information
| Provider Information | |||||||||
| NPI: | 1215321294 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ERNST | ||||||||
| FirstName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 VINCENT ST | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544811842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052593991 | ||||||||
| FaxNumber: | 2056832468 | ||||||||
| Practice Location | |||||||||
| Address1: | N7133 WINNEBAGO DR | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549352722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202513828 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2015 | ||||||||
| LastUpdateDate: | 03/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12921-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT29653 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.