Provider Demographics
NPI:1265995765
Name:ERWIN, TABATHA MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TABATHA
Middle Name:MARIE
Last Name:ERWIN
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:TABATHA
Other - Middle Name:MARIE
Other - Last Name:TRAUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-8519
Mailing Address - Fax:859-258-8592
Practice Address - Street 1:1207 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-8519
Practice Address - Fax:859-258-8592
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30308225100000X
IN05013077A225100000X
KY008168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100903900Medicaid