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General NPI Number Information
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NPI Number | 1922335124
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Entity Type | Individual
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Provider Name | JENNIFER MARIE HERBST PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 835 W WARNER RD SUITE 101-473
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City | GILBERT
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State | AZ
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Zip | 85233-7269
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Country | US
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Telephone | 480-656-7657
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 E SHARI ST
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City | QUEEN CREEK
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State | AZ
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Zip | 85140-4093
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Country | US
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Telephone | 480-358-4072
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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 | 8705
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License Number State | AZ
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