Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8153 | MN |
NPI | 1003072562 |
---|---|
Provider Name | Robert J Herdzina |
First Address | Vadnais Heights, MN 55127-7135 |
Second Address | Vadnais Heights, MN 55127-7135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 29/08/2017 |