Individual
ELIZABETH KRUSER MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8520 W OKLAHOMA AVE, WEST ALLIS, WI 53227-4604
(414) 607-4120
Mailing address
8520 W OKLAHOMA AVE, WEST ALLIS, WI 53227-4604
(414) 607-4120
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10458-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10458-024
PHYSICAL THERAPIST LICENSE
WI
05
—
40464600
—
WI
Enumeration date
04/22/2008
Last updated
04/23/2008
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