Provider Demographics
NPI:1003233321
Name:HERBST, SAMUEL NOAH (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:NOAH
Last Name:HERBST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 SEVEN LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2903
Mailing Address - Country:US
Mailing Address - Phone:301-515-0900
Mailing Address - Fax:240-912-2381
Practice Address - Street 1:1071 SEVEN LOCKS RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2903
Practice Address - Country:US
Practice Address - Phone:301-515-0900
Practice Address - Fax:240-912-2381
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist