Healthcare Provider Details

I. General information

NPI: 1699087106
Provider Name (Legal Business Name): HERBST PHYSICAL THERAPY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220A E JOPPA RD SUITE 234
TOWSON MD
21286-5812
US

IV. Provider business mailing address

1220A E JOPPA RD SUITE 234
TOWSON MD
21286-5812
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-2470
  • Fax: 410-337-2471
Mailing address:
  • Phone: 410-337-2470
  • Fax: 410-337-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18506
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number18506
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number18506
License Number StateMD

VIII. Authorized Official

Name: WENDY ZETS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 410-337-2470