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General NPI Number Information
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NPI Number | 1356673768
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Entity Type | Individual
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Provider Name | CHAD CLARENCE HERGOTT PT
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Gender | Male
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 401 16TH ST SE STE 208
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City | ROCHESTER
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State | MN
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Zip | 55904-7974
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Country | US
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Telephone | 507-923-2139
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Fax | 507-923-2175
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Provider Business Mailing Address
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Address Line | 1939 MINNEHAHA AVE W STE 300
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City | SAINT PAUL
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State | MN
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Zip | 55104-1033
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Country | US
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Telephone | 651-748-4338
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Fax | 651-748-2892
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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 | 7918
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License Number State | MN
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