Basic Information
| Provider Information | |||||||||
| NPI: | 1962747691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAUB | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | BERS | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 E COTTAGE GROVE RD | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535279619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088393515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 251 E COTTAGE GROVE RD | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535279619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088393515 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11696-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.