Healthcare Provider Details

I. General information

NPI: 1265995765
Provider Name (Legal Business Name): TABATHA MARIE ERWIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TABATHA MARIE TRAUNER

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLAISDELL AVE
MINNEAPOLIS MN
55404-2414
US

IV. Provider business mailing address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-1000
  • Fax: 952-993-8039
Mailing address:
  • Phone: 952-883-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008168
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-30308
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013077A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13915
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: