Provider Demographics
NPI:1699087106
Name:HERBST PHYSICAL THERAPY, P.A.
Entity type:Organization
Organization Name:HERBST PHYSICAL THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-337-2470
Mailing Address - Street 1:1220A E JOPPA RD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5812
Mailing Address - Country:US
Mailing Address - Phone:410-337-2470
Mailing Address - Fax:410-337-2471
Practice Address - Street 1:1220A E JOPPA RD
Practice Address - Street 2:SUITE 234
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5812
Practice Address - Country:US
Practice Address - Phone:410-337-2470
Practice Address - Fax:410-337-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18506225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty