Provider Demographics
NPI:1366100133
Name:HERNDON, DAVID (LMT, CLT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HERNDON
Suffix:
Gender:M
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-3449
Mailing Address - Country:US
Mailing Address - Phone:412-551-8857
Mailing Address - Fax:
Practice Address - Street 1:2832 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2739
Practice Address - Country:US
Practice Address - Phone:412-422-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG013439225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist