Provider Demographics
NPI:1609027135
Name:HERD, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-9757
Mailing Address - Country:US
Mailing Address - Phone:610-837-8609
Mailing Address - Fax:
Practice Address - Street 1:2021 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7412
Practice Address - Country:US
Practice Address - Phone:610-865-6077
Practice Address - Fax:610-694-0831
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000540L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant