MEDICARE: MR. JAMES EDWARD HERBERT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT02339	RI
2	225100000X	Physical Therapist	19342	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000370601	OTHER	OH	ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1154389674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES EDWARD HERBERT PT

Provider Business Mailing Address
First Line	:	387 QUARRY ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1025
Country	:	US
Telephone Number	:	774-991-1875
Fax Number	:	774-244-4404

Provider Business Practice Location Address
First Line	:	387 QUARRY ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1025
Country	:	US
Telephone Number	:	774-991-1875
Fax Number	:	774-244-4404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/13/2015

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