Provider Demographics
NPI:1427688498
Name:BARTER, ELIZA WATKINS (DAT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:WATKINS
Last Name:BARTER
Suffix:
Gender:F
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2208
Mailing Address - Country:US
Mailing Address - Phone:847-785-9955
Mailing Address - Fax:
Practice Address - Street 1:24617 75TH ST
Practice Address - Street 2:ATTN: ATHLETIC TRAINER
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-8831
Practice Address - Country:US
Practice Address - Phone:262-843-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2056-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer