Provider Demographics
NPI:1225150923
Name:HERP, MARTHA A (LMT, CMTPT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:HERP
Suffix:
Gender:F
Credentials:LMT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 OCEAN BEACH BLVD
Mailing Address - Street 2:UNIT 505
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5110
Mailing Address - Country:US
Mailing Address - Phone:321-868-6821
Mailing Address - Fax:
Practice Address - Street 1:5050 OCEAN BEACH BLVD
Practice Address - Street 2:UNIT 505
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5110
Practice Address - Country:US
Practice Address - Phone:321-868-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist