Provider Demographics
NPI:1033776984
Name:HEROLD, MORGAN A (ATC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:A
Last Name:HEROLD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N MARKET ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1962
Mailing Address - Country:US
Mailing Address - Phone:717-609-2061
Mailing Address - Fax:
Practice Address - Street 1:114 N MARKET ST APT 2
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1962
Practice Address - Country:US
Practice Address - Phone:717-609-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART006820204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine