Provider Demographics
NPI:1558646802
Name:HERBST, PETER SCOTT (PT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:SCOTT
Last Name:HERBST
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 1:115 FLINT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3058
Mailing Address - Country:US
Mailing Address - Phone:716-632-5600
Mailing Address - Fax:716-632-6516
Practice Address - Street 1:115 FLINT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-3058
Practice Address - Country:US
Practice Address - Phone:716-632-5600
Practice Address - Fax:716-632-6516
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0173372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic