Provider Demographics
NPI:1487860961
Name:HERRERA, DORYS (PT)
Entity Type:Individual
Prefix:
First Name:DORYS
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DORYS
Other - Middle Name:
Other - Last Name:PORTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1565 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5878
Mailing Address - Country:US
Mailing Address - Phone:305-668-9108
Mailing Address - Fax:305-668-9109
Practice Address - Street 1:1565 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-5878
Practice Address - Country:US
Practice Address - Phone:305-668-9108
Practice Address - Fax:305-668-9109
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18986225100000X, 2251E1200X, 2251N0400X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14-1982161OtherEIN