Healthcare Provider Details

I. General information

NPI: 1831153923
Provider Name (Legal Business Name): VICKI DIANE HERR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 ATTUCKS DR SUITE B
POWELL OH
43065-6082
US

IV. Provider business mailing address

3833 ATTUCKS DR SUITE B
POWELL OH
43065-6082
US

V. Phone/Fax

Practice location:
  • Phone: 614-793-8720
  • Fax: 614-793-8722
Mailing address:
  • Phone: 614-793-8720
  • Fax: 614-793-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number003474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: