Provider Demographics
NPI:1912346636
Name:MELVILLE, ELIZABETH CRANE (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CRANE
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DEANE
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:807 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-8150
Mailing Address - Country:US
Mailing Address - Phone:414-224-8219
Mailing Address - Fax:414-224-8246
Practice Address - Street 1:807 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-8150
Practice Address - Country:US
Practice Address - Phone:414-224-8219
Practice Address - Fax:414-224-8246
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12407-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912346636Medicaid
WIK400094900Medicare PIN
WIK100249753Medicare PIN
WI1912346636Medicaid