Provider Demographics
NPI:1306345913
Name:HERMAN, MICHAEL TRAVIS (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TRAVIS
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 DICKERSON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2884
Mailing Address - Country:US
Mailing Address - Phone:704-283-6700
Mailing Address - Fax:704-283-6713
Practice Address - Street 1:1730 DICKERSON BLVD STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2884
Practice Address - Country:US
Practice Address - Phone:704-283-6700
Practice Address - Fax:704-283-6713
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist