Provider Demographics
NPI:1730301664
Name:HERARD, GRACE-ANNE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:GRACE-ANNE
Middle Name:MARIE
Last Name:HERARD
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 1:8041 TIERNEYS WOODS ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438
Mailing Address - Country:US
Mailing Address - Phone:952-941-0681
Mailing Address - Fax:
Practice Address - Street 1:ABBOTT NORTHWESTERN HOSPITAL
Practice Address - Street 2:800 EAST 28TH STREET
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-819-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7666225100000X
NY013520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist