Provider Demographics
NPI:1346456704
Name:HERZEL, EDITH LEONA (PT)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:LEONA
Last Name:HERZEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GUN FLINT TR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732
Mailing Address - Country:US
Mailing Address - Phone:828-628-3604
Mailing Address - Fax:828-628-3604
Practice Address - Street 1:13 GUN FLINT TR
Practice Address - Street 2:FLETCHER NO 2
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732
Practice Address - Country:US
Practice Address - Phone:828-628-3604
Practice Address - Fax:828-628-3604
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07837OtherBCBS