Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 14547 | NC |
N | 2251X0800X | Physical Therapist - Orthopedic | 14547 | NC |
NPI | 1013345875 |
---|---|
Provider Name | Krista Herbst |
First Address | Greensboro, NC 27408-7616 |
Second Address | Greensboro, NC 27408-7616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2013 |
Last Update Date | 14/10/2013 |