Healthcare Provider Details

I. General information

NPI: 1659523637
Provider Name (Legal Business Name): CARL DAVID HERRINGTON MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID HERRINGTON

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 N HIGHWAY 67
FLORISSANT MO
63031-5108
US

IV. Provider business mailing address

13537 BARRETT PARKWAY DR SUITE 105
BALLWIN MO
63021-5899
US

V. Phone/Fax

Practice location:
  • Phone: 314-972-1442
  • Fax: 314-972-1533
Mailing address:
  • Phone: 314-821-9126
  • Fax: 314-821-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2009000291
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: