Provider Demographics
NPI:1518243971
Name:HERZOG, ANTHONY M (DPT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:HERZOG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2284 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4685
Mailing Address - Country:US
Mailing Address - Phone:724-788-1770
Mailing Address - Fax:724-788-1994
Practice Address - Street 1:2284 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4685
Practice Address - Country:US
Practice Address - Phone:724-788-1770
Practice Address - Fax:724-788-1994
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist