Provider Demographics
NPI:1679292973
Name:HERRON, DOUGLAS ALLAN (MPT, PT, CLT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALLAN
Last Name:HERRON
Suffix:
Gender:M
Credentials:MPT, PT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N ARLINGTON AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4448
Mailing Address - Country:US
Mailing Address - Phone:775-530-4353
Mailing Address - Fax:
Practice Address - Street 1:645 N ARLINGTON AVE STE 350
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4448
Practice Address - Country:US
Practice Address - Phone:775-530-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12442251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary