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NPI Code Detail

MEDICARE: CYNTHIA MARIE HERETH

MEDICARE: CYNTHIA MARIE HERETH
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
1225200000XPhysical Therapy Assistant2732-19WI

General Provider Information

NPI Number : 1265932495
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA MARIE HERETH
Provider Business Mailing Address
First Line : 9806 W LINCOLN AVE
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-2234
Country : US
Telephone Number : 414-543-5330
Fax Number :
Provider Business Practice Location Address
First Line : 9806 W LINCOLN AVE
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-2234
Country : US
Telephone Number : 414-543-5330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 02/14/2018

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