Provider Demographics
NPI:1043551559
Name:HERBICK, ZACHARY THOMAS (PTA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:THOMAS
Last Name:HERBICK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 DENNY ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1730
Mailing Address - Country:US
Mailing Address - Phone:315-276-9726
Mailing Address - Fax:
Practice Address - Street 1:1 TERRACE HTS
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-9515
Practice Address - Country:US
Practice Address - Phone:607-847-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008670-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant