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NPI Code Detail

MEDICARE: MARK SCOTT HERBERT

MEDICARE: MARK SCOTT HERBERT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2986WI

General Provider Information

NPI Number : 1003178807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK SCOTT HERBERT
Provider Business Mailing Address
First Line : N4231 STATE HIGHWAY 22
Second Line :
City : SHAWANO
State : WI
Zip : 54166-6130
Country : US
Telephone Number : 715-526-3158
Fax Number : 715-526-6225
Provider Business Practice Location Address
First Line : N4231 STATE HIGHWAY 22
Second Line :
City : SHAWANO
State : WI
Zip : 54166-6130
Country : US
Telephone Number : 715-526-3158
Fax Number : 715-526-6225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2012
Last Update Date : 06/08/2012

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Directions to “ MARK SCOTT HERBERT ” Practice Location

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