Provider Demographics
NPI:1417499450
Name:HERRON, RICHARD II (ATC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HERRON
Suffix:II
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ROBINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8803
Mailing Address - Country:US
Mailing Address - Phone:724-815-6294
Mailing Address - Fax:
Practice Address - Street 1:1301 ROBINWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8803
Practice Address - Country:US
Practice Address - Phone:724-815-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0060002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer