Healthcare Provider Details

I. General information

NPI: 1568191930
Provider Name (Legal Business Name): TIA MARIE DEMERS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA MARIE DEMERS DPT

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S WISCONSIN AVE STE A
RICE LAKE WI
54868-7532
US

IV. Provider business mailing address

517 E CLAIREMONT AVE
EAU CLAIRE WI
54701-6479
US

V. Phone/Fax

Practice location:
  • Phone: 715-236-3610
  • Fax: 715-236-3615
Mailing address:
  • Phone: 715-855-0408
  • Fax: 715-855-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15827-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: