Basic Information
| Provider Information | |||||||||
| NPI: | 1699087106 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERBST PHYSICAL THERAPY, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220A E JOPPA RD | ||||||||
| Address2: | SUITE 234 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212865812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103372470 | ||||||||
| FaxNumber: | 4103372471 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220A E JOPPA RD | ||||||||
| Address2: | SUITE 234 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212865812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103372470 | ||||||||
| FaxNumber: | 4103372471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2010 | ||||||||
| LastUpdateDate: | 07/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | ZETS | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4103372470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | 18506 | MD | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 2251X0800X | 18506 | MD | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 18506 | MD | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.