Provider Demographics
NPI:1346585890
Name:HERRICK, MATTHEW EMERSON (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EMERSON
Last Name:HERRICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HIGHWAY 74 S
Mailing Address - Street 2:SUITE 720
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3081
Mailing Address - Country:US
Mailing Address - Phone:770-632-6800
Mailing Address - Fax:770-632-6060
Practice Address - Street 1:611 HIGHWAY 74 S
Practice Address - Street 2:SUITE 720
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3081
Practice Address - Country:US
Practice Address - Phone:770-632-6800
Practice Address - Fax:770-632-6060
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist