Provider Demographics
NPI:1598430035
Name:HERRMANN, JARED THOMAS (DPT)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:THOMAS
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4172
Mailing Address - Country:US
Mailing Address - Phone:215-834-9571
Mailing Address - Fax:
Practice Address - Street 1:12285 MCNULTY RD STE 103
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1210
Practice Address - Country:US
Practice Address - Phone:215-576-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist