Provider Demographics
NPI:1649359712
Name:OVERMAN, HERMAN BOYD JR (LPT)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:BOYD
Last Name:OVERMAN
Suffix:JR
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7594
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0594
Mailing Address - Country:US
Mailing Address - Phone:252-443-0808
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:505 GREENVILLE BLVD SE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6736
Practice Address - Country:US
Practice Address - Phone:252-355-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC199853OtherMEDCOST
NC0775GOtherBCBSNC
NC0775GOtherBCBSNC
NC199853OtherMEDCOST