Provider Demographics
NPI:1508001728
Name:HERBERT, THOMAS J (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HERBERT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:ATTN CREDENTIALING DEPT
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:105A NEWTOWN ROAD
Practice Address - Street 2:SUITE #5
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4120
Practice Address - Country:US
Practice Address - Phone:203-739-0765
Practice Address - Fax:203-739-0792
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083202251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics