Provider Demographics
NPI:1184294779
Name:BIRENBAUM, EMILY K (PT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:BIRENBAUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:K
Other - Last Name:MEINNERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2801 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2894
Mailing Address - Country:US
Mailing Address - Phone:920-337-1122
Mailing Address - Fax:920-337-1126
Practice Address - Street 1:2801 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2894
Practice Address - Country:US
Practice Address - Phone:920-337-1122
Practice Address - Fax:920-337-1126
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1548216484Medicaid