Provider Demographics
NPI:1356673768
Name:HERGOTT, CHAD CLARENCE (PT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:CLARENCE
Last Name:HERGOTT
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:401 16TH ST SE STE 208
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7974
Practice Address - Country:US
Practice Address - Phone:507-923-2139
Practice Address - Fax:507-923-2175
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN7918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist