Provider Demographics
NPI:1003516642
Name:HERATY, COLIN
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:HERATY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1427
Mailing Address - Country:US
Mailing Address - Phone:507-858-5523
Mailing Address - Fax:
Practice Address - Street 1:406 MAIN ST E
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1427
Practice Address - Country:US
Practice Address - Phone:507-858-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer