Provider Demographics
NPI:1336497858
Name:HERBOLICH, RICHARD F (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:HERBOLICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2537 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3201
Mailing Address - Country:US
Mailing Address - Phone:859-277-5703
Mailing Address - Fax:859-275-1624
Practice Address - Street 1:2537 LARKIN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3201
Practice Address - Country:US
Practice Address - Phone:859-277-5703
Practice Address - Fax:859-275-1624
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000901OtherSTATE LICENSE