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General NPI Number Information
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NPI Number | 1053640599
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Entity Type | Individual
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Provider Name | JEANNE A. HERGENROTHER PT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 2050 S MAIN ST
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City | DELTA
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State | CO
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Zip | 81416-2407
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Country | US
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Telephone | 970-874-9773
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1352
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-1352
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Country | US
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Telephone | 970-731-7474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5647
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License Number State | CO
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