Provider Demographics
NPI:1942373147
Name:HERZOG, BARBARA ANN (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:HERZOG
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 1:11343 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9541
Mailing Address - Country:US
Mailing Address - Phone:248-640-4991
Mailing Address - Fax:
Practice Address - Street 1:11343 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9541
Practice Address - Country:US
Practice Address - Phone:248-640-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211069Medicare PIN
MIN69750090Medicare PIN