Provider Demographics
NPI:1003197179
Name:HERYNK, RACHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:HERYNK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 BOW ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5652
Mailing Address - Country:US
Mailing Address - Phone:406-549-5283
Mailing Address - Fax:406-549-5392
Practice Address - Street 1:1705 BOW ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5652
Practice Address - Country:US
Practice Address - Phone:406-549-5283
Practice Address - Fax:406-549-5392
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2408PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist