MEDICARE: BRETT TABER PT

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	225100000X	Physical Therapist	13746	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13746	OTHER	WI	WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES

General Provider Information

NPI Number	:	1861918229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT TABER PT

Provider Business Mailing Address
First Line	:	3205 LOTHEVILLE RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-2701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 OAK ST
Second Line	:
City	:	PRAIRIE DU SAC
State	:	WI
Zip	:	53578-1554
Country	:	US
Telephone Number	:	608-643-7572
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	08/17/2017

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Directions to “ BRETT TABER PT” Practice Location

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