Provider Demographics
NPI:1215900642
Name:HERZOG, VALERIE WIRTH (EDD, ATC)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:WIRTH
Last Name:HERZOG
Suffix:
Gender:F
Credentials:EDD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 VILLAGE DR
Mailing Address - Street 2:DEPT. 2801
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84408-2801
Mailing Address - Country:US
Mailing Address - Phone:801-626-7656
Mailing Address - Fax:
Practice Address - Street 1:1435 VILLAGE DR
Practice Address - Street 2:DEPT. 2801
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-2801
Practice Address - Country:US
Practice Address - Phone:801-626-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer