Provider Demographics
NPI:1700944220
Name:HERRITY, MARY BETH (PT)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:HERRITY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE #400
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5939
Mailing Address - Country:US
Mailing Address - Phone:703-354-1230
Mailing Address - Fax:703-354-5691
Practice Address - Street 1:7023 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE #400
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5939
Practice Address - Country:US
Practice Address - Phone:703-354-1230
Practice Address - Fax:703-354-5691
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0105-003408208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192825OtherANTHEM INSURANCE CO
VAG01703001Medicare ID - Type Unspecified