Provider Demographics
NPI:1346799236
Name:HERRERA, SAMANTHA RAE KLAWIN (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE KLAWIN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:RAE
Other - Last Name:KLAWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1782
Mailing Address - Country:US
Mailing Address - Phone:424-248-0100
Mailing Address - Fax:
Practice Address - Street 1:11600 WILSHIRE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1782
Practice Address - Country:US
Practice Address - Phone:424-248-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist