Provider Demographics
NPI:1568556090
Name:ERNST, ANNE M (MPT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:ERNST
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:KAPELLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:7860 BLACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2875 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3114
Practice Address - Country:US
Practice Address - Phone:608-204-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013841225100000X
WI10328-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36164100Medicaid