Healthcare Provider Details

I. General information

NPI: 1659310977
Provider Name (Legal Business Name): ERIN E GASSER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SCIENCE DR
MADISON WI
53711-1074
US

IV. Provider business mailing address

5819 CHESAPEAKE CIR
FITCHBURG WI
53719-1600
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-8808
  • Fax:
Mailing address:
  • Phone: 419-979-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1510-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: