Healthcare Provider Details

I. General information

NPI: 1356760920
Provider Name (Legal Business Name): MARGO HERMAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 S MERCY RD STE 121
GILBERT AZ
85297
US

IV. Provider business mailing address

2108 E THOMAS RD STE 130
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-2263
  • Fax: 602-933-4256
Mailing address:
  • Phone: 602-933-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12138
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: