Provider Demographics
NPI:1285698944
Name:HEROD, RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:HEROD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WILLOW LAWN DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3003
Mailing Address - Country:US
Mailing Address - Phone:804-340-1193
Mailing Address - Fax:804-340-1930
Practice Address - Street 1:3805 CUTSHAW AVE
Practice Address - Street 2:SUITE 299
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-340-1193
Practice Address - Fax:804-340-1930
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3771806OtherAETNA
412143526OtherPHCS
541999128OtherPHCS
6404543OtherUNITED HEALTHCARE
181683OtherHEALTHKEEPERS
429173OtherMAMSI
6400713OtherUNITED HEALTHCARE
VA8941653Medicaid
412143526OtherCIGNA
429180OtherMAMSI
P00040375OtherRR MEDICARE
P002340000OtherRR MEDICARE
143284OtherANTHEM PPO
2622581OtherAETNA
3771806OtherAETNA HMO
VAC09247Medicare PIN
6404543OtherUNITED HEALTHCARE
2622581OtherAETNA
VAC06575Medicare PIN