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Organization
TEMPLE ERGONOMICS LLC
Active
Organization
TEMPLE ERGONOMICS LLC
Active
Other names
Temple Ergonomics Home Physical Therapy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD THEODORE TATE M.P.T. (PRESIDENT)
(920) 427-0350
Entity
Organization
Contact information
Practice address
4835 N CHERRYVALE AVE, APPLETON, WI 54913-9383
(920) 427-0350
Mailing address
4835 N CHERRYVALE AVE, APPLETON, WI 54913-9383
(920) 427-0350
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9723-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WI1702
MEDICARE PTAN
WI
01
—
WI1702001
MEDICARE INDIVIDUAL PTAN
WI
Enumeration date
08/21/2006
Last updated
04/22/2013
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