Individual
DR. MAGGIE E HERETICK
Active
Individual
DR. MAGGIE E HERETICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305203281
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139048
BC/BS
VA
01
—
393097
MAMSI
VA
01
—
P00199901
RAILROAD MEDICARE
VA
Enumeration date
07/04/2006
Last updated
07/08/2007
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