Provider Demographics
NPI:1316047590
Name:HERMEL, NICHOL M (PT)
Entity type:Individual
Prefix:
First Name:NICHOL
Middle Name:M
Last Name:HERMEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-9176
Mailing Address - Country:US
Mailing Address - Phone:715-253-2939
Mailing Address - Fax:715-253-2930
Practice Address - Street 1:105 N GENESEE ST
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-9176
Practice Address - Country:US
Practice Address - Phone:715-253-2939
Practice Address - Fax:715-253-2930
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40473300Medicaid
WI006183450Medicare ID - Type Unspecified