Provider Demographics
NPI:1528175833
Name:ERDMANN, DAVID F (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:ERDMANN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2000
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:205 W GREEN BAY ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2333
Practice Address - Country:US
Practice Address - Phone:715-526-5433
Practice Address - Fax:715-526-6930
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3059-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI118212OtherSECURITY HEALTH PLAN
WI40399800Medicaid
MN625A1EROtherBCBS OF MN
WI64-07741OtherMEDICA
MN625A0EROtherBCBS OF MN
WV64-07742OtherMEDICA
WI64-07743OtherMEDICA
WI118214OtherSECURITY HEALTH PLAN