MEDICARE: MR. THOMAS HERRMANN PT, ATC, EDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	PT8022	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ9603	OTHER	OH	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000000178624	OTHER	OH	ANTHEM PIN

General Provider Information

NPI Number	:	1891768834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS HERRMANN PT, ATC, EDD

Provider Business Mailing Address
First Line	:	9419 KENWOOD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-6811
Country	:	US
Telephone Number	:	513-792-0777
Fax Number	:	513-792-0061

Provider Business Practice Location Address
First Line	:	5260 CROOKSHANK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3306
Country	:	US
Telephone Number	:	513-792-0777
Fax Number	:	513-792-0061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	01/15/2008

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