Provider Demographics
NPI:1689983645
Name:HERCULES, MARY S (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:HERCULES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 ZUMBEHL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2761
Mailing Address - Country:US
Mailing Address - Phone:636-947-7678
Mailing Address - Fax:636-947-4350
Practice Address - Street 1:1840 ZUMBEHL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2761
Practice Address - Country:US
Practice Address - Phone:636-947-7678
Practice Address - Fax:636-947-4350
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR09982251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports