Provider Demographics
NPI:1417602525
Name:HERRERA, DAVID ISRAEL (DPT,PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ISRAEL
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DPT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-1207
Mailing Address - Country:US
Mailing Address - Phone:575-637-0905
Mailing Address - Fax:
Practice Address - Street 1:507 WILLOW DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-1207
Practice Address - Country:US
Practice Address - Phone:575-637-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty