Provider Demographics
NPI:1750471827
Name:ELLEFSON, KAREN A (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:ELLEFSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:ZBIKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:W231 S7680 BIG BEND DR
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103
Mailing Address - Country:US
Mailing Address - Phone:262-662-9760
Mailing Address - Fax:262-662-9761
Practice Address - Street 1:W231 S7680 BIG BEND DR
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103
Practice Address - Country:US
Practice Address - Phone:262-662-9760
Practice Address - Fax:262-662-9761
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI024-918225100000X
WI918-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40007500Medicaid
WI40007800Medicaid
WI000186504OtherMEDICARE