Provider Demographics
NPI:1376593855
Name:HERRERA, BRIAN ANTHONY (DPT, MSPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ANTHONY
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DPT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BADGER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3201
Mailing Address - Country:US
Mailing Address - Phone:516-682-8560
Mailing Address - Fax:516-682-8562
Practice Address - Street 1:50 MAPLE PL
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1927
Practice Address - Country:US
Practice Address - Phone:516-682-8560
Practice Address - Fax:516-682-8562
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist