Provider Demographics
NPI:1578847133
Name:HERBERT, DENISE ROSE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ROSE
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 1:33 TALL MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9107
Mailing Address - Country:US
Mailing Address - Phone:607-738-1701
Mailing Address - Fax:
Practice Address - Street 1:33 TALL MEADOW CT
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9107
Practice Address - Country:US
Practice Address - Phone:607-738-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034135-12251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics