Provider Demographics
NPI:1578322764
Name:ELSING, THOR JEFFREY (PTA)
Entity Type:Individual
Prefix:MR
First Name:THOR
Middle Name:JEFFREY
Last Name:ELSING
Suffix:
Gender:M
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:W173N10915 BERNIES WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4043
Mailing Address - Country:US
Mailing Address - Phone:262-509-3300
Mailing Address - Fax:262-251-7359
Practice Address - Street 1:W173N10915 BERNIES WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4043
Practice Address - Country:US
Practice Address - Phone:262-509-3300
Practice Address - Fax:262-251-7359
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2815225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant