Individual
CHARLES HERBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
180 E HIGHWAY 550, SUITE E, BERNALILLO, NM 87004-5967
(505) 771-2447
(505) 771-2360
Mailing address
535 HWY 314 SW, LOS LUNAS, NM 87031-9600
(505) 866-0055
(505) 866-0057
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3741
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Q0406
—
NM
01
—
1245380039
BERNALILLO FACILITY NPI
NM
01
—
1386651412
BILLING NPI
NM
Enumeration date
09/02/2009
Last updated
04/19/2010
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