Provider Demographics
NPI:1760547038
Name:HERRON, ANDREW R (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:HERRON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 CAMBRIDGE STREET
Mailing Address - Street 2:C/O ORTHOPAEDICS PLUS
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:781-229-8011
Mailing Address - Fax:781-229-8011
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 121Q
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-927-0907
Practice Address - Fax:978-927-0537
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA15022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0396281Medicaid
MA0396281Medicaid