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NPI Code Detail

MEDICARE: MRS. LEIGH ANN HERTTER PTA

MEDICARE:  MRS. LEIGH ANN HERTTER  PTA
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
1225200000XPhysical Therapy AssistantIL

General Provider Information

NPI Number : 1134232861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LEIGH ANN HERTTER PTA
Provider Business Mailing Address
First Line : PO BOX 43
Second Line :
City : GOLCONDA
State : IL
Zip : 62938-0043
Country : US
Telephone Number : 618-841-0311
Fax Number :
Provider Business Practice Location Address
First Line : 3111 WILLIAMSON COUNTY PKWY
Second Line :
City : MARION
State : IL
Zip : 62959-5235
Country : US
Telephone Number : 618-998-9894
Fax Number : 618-998-9993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LEIGH ANN HERTTER PTA” Practice Location

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