Provider Demographics
NPI:1720261670
Name:GEHL, ELIZABETH M (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:GEHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N64W24086 MAIN ST
Mailing Address - Street 2:PO BOX 127
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3002
Mailing Address - Country:US
Mailing Address - Phone:262-246-8009
Mailing Address - Fax:262-246-4431
Practice Address - Street 1:N64W24086 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3002
Practice Address - Country:US
Practice Address - Phone:262-246-8009
Practice Address - Fax:262-246-4431
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9583024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist