Individual
ELISE M WALLGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
9000 W SURA LN, GREENFIELD, WI 53228-3477
(414) 246-6800
(414) 246-6405
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 246-6800
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15889
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100205207
—
WI
Enumeration date
06/30/2022
Last updated
08/04/2022
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