Provider Demographics
NPI:1235332891
Name:HERRERA, JAIME JOSHUA (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:JOSHUA
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:JOSHUA
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2210 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6847
Mailing Address - Country:US
Mailing Address - Phone:765-860-6641
Mailing Address - Fax:
Practice Address - Street 1:1015 N TEXAS BLVD
Practice Address - Street 2:STE 20B-201
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4529
Practice Address - Country:US
Practice Address - Phone:765-860-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1193443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist