Provider Demographics
NPI:1962676239
Name:WILHELMSON, ELIZABETH JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:WILHELMSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:JEAN
Other - Last Name:ARKULARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4721 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1518
Mailing Address - Country:US
Mailing Address - Phone:218-525-6567
Mailing Address - Fax:
Practice Address - Street 1:4721 DODGE ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-1518
Practice Address - Country:US
Practice Address - Phone:218-525-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3664-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40156600Medicaid