Individual
ELIZABETH J BASAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4750
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7226
(920) 445-7229
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10319-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40450700
—
WI
Enumeration date
06/13/2007
Last updated
11/22/2021
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