Provider Demographics
NPI:1508203977
Name:HERBERT, EDA (PT)
Entity Type:Individual
Prefix:MS
First Name:EDA
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-2006
Mailing Address - Country:US
Mailing Address - Phone:215-317-6474
Mailing Address - Fax:
Practice Address - Street 1:113 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-2006
Practice Address - Country:US
Practice Address - Phone:215-317-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-25
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT004138E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist