Individual
ELIZABETH S CHUMANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
621 SCIENCE DR, MADISON, WI 53711-1074
(608) 263-8850
Mailing address
6630 UNIVERSITY AVE, MIDDLETON, WI 53562-3036
(608) 265-0104
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12130-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12130
PT LICENSE
WI
05
—
1932456373
—
WI
Enumeration date
08/03/2012
Last updated
10/22/2012
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