Provider Demographics
NPI:1306154299
Name:BURCH, ELIZABETH I (DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:I
Last Name:BURCH
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:N6135 WOODLAND MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3347
Mailing Address - Country:US
Mailing Address - Phone:920-207-8855
Mailing Address - Fax:
Practice Address - Street 1:650 CENTENNIAL CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:WI
Practice Address - Zip Code:54155-8989
Practice Address - Country:US
Practice Address - Phone:920-600-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11607-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist