Provider Demographics
NPI:1760052153
Name:HERRERA-KESELRING, NATHAN JP (PTA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JP
Last Name:HERRERA-KESELRING
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 ZAPATA CIR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3380
Mailing Address - Country:US
Mailing Address - Phone:361-877-8508
Mailing Address - Fax:
Practice Address - Street 1:529 ZAPATA CIR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3380
Practice Address - Country:US
Practice Address - Phone:361-877-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2128468208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation