Provider Demographics
NPI:1992898951
Name:HERR, GARRICK DICK (PT, DPT)
Entity type:Individual
Prefix:
First Name:GARRICK
Middle Name:DICK
Last Name:HERR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 N MERIDIAN PL
Mailing Address - Street 2:STE A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7215
Mailing Address - Country:US
Mailing Address - Phone:907-631-4029
Mailing Address - Fax:
Practice Address - Street 1:3750 E COUNTRY FIELD CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6689
Practice Address - Country:US
Practice Address - Phone:907-376-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist