MEDICARE: JULIE MARIE HERMSEN

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	225200000X	Physical Therapy Assistant	493-19	WI

General Provider Information

NPI Number	:	1285055541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MARIE HERMSEN

Provider Business Mailing Address
First Line	:	1250 S EVERGREEN ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-3514
Country	:	US
Telephone Number	:	715-526-3107
Fax Number	:	715-525-8037

Provider Business Practice Location Address
First Line	:	1475 BIRCH HILL LN
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-3707
Country	:	US
Telephone Number	:	715-526-3161
Fax Number	:	715-524-5896

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

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	01/24/2025

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