Provider Demographics
NPI:1811900533
Name:HERMAN, HEIDI E (PT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:E
Last Name:HERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WELLNESS BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-749-0808
Mailing Address - Fax:803-749-0308
Practice Address - Street 1:1 WELLNESS BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-749-0808
Practice Address - Fax:803-749-0308
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011935225100000X
SC6844225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00235541OtherRAILROAD MEDICARE
MIP09920003Medicare ID - Type Unspecified
MIP00235541OtherRAILROAD MEDICARE