Provider Demographics
NPI:1659481893
Name:HERTEL AND BROWN PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:HERTEL AND BROWN PHYSICAL THERAPY, P.C.
Other - Org Name:HERTEL AND BROWN SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCHTOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-969-6680
Mailing Address - Street 1:2147 W 12TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4835
Mailing Address - Country:US
Mailing Address - Phone:814-456-6000
Mailing Address - Fax:814-456-6060
Practice Address - Street 1:2147 W 12TH ST STE 1
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4835
Practice Address - Country:US
Practice Address - Phone:814-456-6000
Practice Address - Fax:814-456-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016791225100000X, 225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10191583200002Medicaid
PA1910451OtherBS
PA1019158320001Medicaid
PA108614Medicare UPIN