Provider Demographics
NPI:1174747208
Name:AUSSPRUNG, DEANNA ELLIOTT (PT, LAT, CSCS)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:ELLIOTT
Last Name:AUSSPRUNG
Suffix:
Gender:F
Credentials:PT, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4834 MORRIS CT
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-9163
Mailing Address - Country:US
Mailing Address - Phone:608-658-5352
Mailing Address - Fax:888-965-4018
Practice Address - Street 1:313 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2613
Practice Address - Country:US
Practice Address - Phone:608-658-5352
Practice Address - Fax:888-965-4018
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI450392255A2300X
WI2580-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer