Individual ProviderMarykay HeruthPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address13986 Maple Knoll Way, Maple Grove, MN 55369-4655(763) 236-0200(612) 262-4813PECOS EnrollmentBased on the most recent information from CMS, provider Marykay Heruth does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1134182504Provider TypeIndividualFull NameHeruth, MarykayCredentialPTGenderFemaleEnumeration Date4/7/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address13986 Maple Knoll Way, Maple Grove, MN 55369-4655Phone(763) 236-0200FaxUnlisted FaxMailing LocationMailing AddressPO Box 43, Mr 10809, Minneapolis, MN 55440-0043Phone(612) 262-4813Fax(612) 262-4194Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense806Minnesota