Provider Demographics
NPI:1326371576
Name:HERRERA-WOLF, BRENDA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:HERRERA-WOLF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:17270 RED OAK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2618
Mailing Address - Country:US
Mailing Address - Phone:281-440-6960
Mailing Address - Fax:
Practice Address - Street 1:17270 RED OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2618
Practice Address - Country:US
Practice Address - Phone:281-440-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041432225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE PIN NUMBER
TX00J21AOtherGROUP MEDICARE PIN NUMBER