Provider Demographics
NPI:1396184032
Name:HERRICK, CHARLES W (MSPT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:HERRICK
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3904
Mailing Address - Country:US
Mailing Address - Phone:978-388-5438
Mailing Address - Fax:
Practice Address - Street 1:50 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3904
Practice Address - Country:US
Practice Address - Phone:978-388-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2868225100000X
MA13122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist