Provider Demographics
NPI:1124782214
Name:FALLER, ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FALLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 BREWSTER DR APT 7
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1783
Mailing Address - Country:US
Mailing Address - Phone:608-385-4303
Mailing Address - Fax:
Practice Address - Street 1:7901 S 6TH ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2010
Practice Address - Country:US
Practice Address - Phone:414-346-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist