Provider Demographics
NPI:1619275088
Name:HERBERT, REBECCA (MPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2103
Mailing Address - Country:US
Mailing Address - Phone:732-822-0799
Mailing Address - Fax:732-681-0299
Practice Address - Street 1:407 3RD AVE
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2103
Practice Address - Country:US
Practice Address - Phone:732-822-0799
Practice Address - Fax:732-681-0299
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00921300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist