Healthcare Provider Details

I. General information

NPI: 1700504495
Provider Name (Legal Business Name): COURTNEY BRIANA HERSCH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

6306 S MACDILL AVE APT 1830
TAMPA FL
33611-5083
US

V. Phone/Fax

Practice location:
  • Phone: 813-643-1389
  • Fax:
Mailing address:
  • Phone: 239-634-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT39057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: