Provider Demographics
NPI:1700076759
Name:HERRMANN, STEPHEN (ATC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-2039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-2039
Practice Address - Country:US
Practice Address - Phone:319-346-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer