Basic Information
| Provider Information | |||||||||
| NPI: | 1003557877 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HERBST | ||||||||
| FirstName: | ALEXA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 MARIAH DR | ||||||||
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| City: | FOLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563298730 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1406 6TH AVE N | ||||||||
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| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563031900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202512700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2022 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Y00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Clinical Exercise Physiologist |
No ID Information.