Provider Demographics
NPI:1053821439
Name:DEVOE, ELIZA (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:DEVOE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2011 COUNTY HIGHWAY M
Mailing Address - Street 2:
Mailing Address - City:SARONA
Mailing Address - State:WI
Mailing Address - Zip Code:54870-9286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1280 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-2202
Practice Address - Country:US
Practice Address - Phone:715-939-1624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13049-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist