Provider Demographics
NPI:1083273643
Name:HERMAN, THOMAS RUSSELL (DPT, PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RUSSELL
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3311
Mailing Address - Country:US
Mailing Address - Phone:412-715-5645
Mailing Address - Fax:
Practice Address - Street 1:495 E WATERFRONT DR STE 240
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1151
Practice Address - Country:US
Practice Address - Phone:412-325-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist