Provider Demographics
NPI:1689714321
Name:HERBERT, NANCY
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:HERBERT
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 1:905 BARDOT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-1703
Mailing Address - Country:US
Mailing Address - Phone:636-629-3500
Mailing Address - Fax:636-629-4466
Practice Address - Street 1:905 BARDOT ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-1703
Practice Address - Country:US
Practice Address - Phone:636-629-3500
Practice Address - Fax:636-629-4466
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist