Provider Demographics
NPI:1619937612
Name:FEUTZ, ELIZABETH BROWN (ATC, LAT,CSCS)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:BROWN
Last Name:FEUTZ
Suffix:
Gender:F
Credentials:ATC, LAT,CSCS
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:BROWN
Other - Last Name:FEUTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2021A W WOODRIVER DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2002
Mailing Address - Country:US
Mailing Address - Phone:314-374-0987
Mailing Address - Fax:
Practice Address - Street 1:INTERCOLLEGIATE ATHLETICS LINGLE HALL RM 118
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-453-5482
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer