Individual
MR. BYRON J. HERIGSTAD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
120-C N EVEREST RD, NEWBERG, OR 97132
(503) 538-8952
(503) 537-2027
Mailing address
20400 NE NIEDERBERGER RD, DUNDEE, OR 97115-9005
(503) 538-5841
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1549
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071014
—
OR
01
—
318492
PROVIDENCE HEALTH PLAN
OR
01
—
5732048
AETNA
OR
01
—
K7283 01
PACIFIC SOURCE
OR
Enumeration date
02/22/2006
Last updated
07/08/2007
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