Healthcare Provider Details

I. General information

NPI: 1831530864
Provider Name (Legal Business Name): ROBERT ERIC HERBERT RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

167 DEER TRACK LN
MONCKS CORNER SC
29461-7813
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7580
  • Fax:
Mailing address:
  • Phone: 843-412-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number1854
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: