Provider Demographics
NPI:1700831310
Name:ANDREWS, ELIZA MARIA TERESA (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:MARIA TERESA
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ELIZA
Other - Middle Name:MARIA TERESA
Other - Last Name:CAPPELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3852 CREAMERY RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9210
Mailing Address - Country:US
Mailing Address - Phone:920-338-9670
Mailing Address - Fax:920-338-9680
Practice Address - Street 1:3852 CREAMERY RD
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9210
Practice Address - Country:US
Practice Address - Phone:920-338-9670
Practice Address - Fax:920-338-9680
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4767-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7266513OtherAETNA PROVIDER PW
WI40241300Medicaid
11452706OtherCAQH CREDENTIAL NUMBER
Q34019001Medicare UPIN