Provider Demographics
NPI:1457188583
Name:HERGET, CARLY MAE
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:MAE
Last Name:HERGET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 HILLSBORO HOUSE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-3602
Mailing Address - Country:US
Mailing Address - Phone:636-495-5508
Mailing Address - Fax:
Practice Address - Street 1:610 VINELAND SCHOOL RD
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-2561
Practice Address - Country:US
Practice Address - Phone:636-586-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024032825225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant