Provider Demographics
NPI:1497066591
Name:HERWEYER, MARJORIE A (RPT)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:A
Last Name:HERWEYER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27551 SHADOW MOUNTAIN DR
Mailing Address - Street 2:PO BOX 843
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-8607
Mailing Address - Country:US
Mailing Address - Phone:303-838-7197
Mailing Address - Fax:303-838-7197
Practice Address - Street 1:27551 SHADOW MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-8607
Practice Address - Country:US
Practice Address - Phone:303-838-7197
Practice Address - Fax:303-838-7197
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1240225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist