Provider Demographics
NPI:1972708824
Name:GEHRMANN, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:GEHRMANN
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 1:2801 COHO ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4574
Mailing Address - Country:US
Mailing Address - Phone:608-273-3232
Mailing Address - Fax:608-273-3426
Practice Address - Street 1:2801 COHO ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4574
Practice Address - Country:US
Practice Address - Phone:608-273-3232
Practice Address - Fax:608-273-3426
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9654-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40357100Medicaid