Provider Demographics
NPI:1285055541
Name:HERMSEN, JULIE MARIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:HERMSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3514
Mailing Address - Country:US
Mailing Address - Phone:715-526-3107
Mailing Address - Fax:715-525-8037
Practice Address - Street 1:1475 BIRCH HILL LN
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3707
Practice Address - Country:US
Practice Address - Phone:715-526-3161
Practice Address - Fax:715-524-5896
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI493-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant