Basic Information
| Provider Information | |||||||||
| NPI: | 1972173409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | ALLISYN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 WATSON ST | ||||||||
| Address2: | |||||||||
| City: | RIPON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549711755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083861073 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 S OAKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | OSHKOSH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549047944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202232000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2021 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15486-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.