Provider Demographics
NPI:1073195012
Name:FRUNER, ELIZABETH V (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:V
Last Name:FRUNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-2110
Mailing Address - Country:US
Mailing Address - Phone:360-917-5253
Mailing Address - Fax:
Practice Address - Street 1:678 2ND ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6901
Practice Address - Country:US
Practice Address - Phone:707-938-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49804208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation