Provider Demographics
NPI:1932512290
Name:HERRA, RODNEY LYNN JR
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:LYNN
Last Name:HERRA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-6441
Mailing Address - Country:US
Mailing Address - Phone:423-664-5238
Mailing Address - Fax:
Practice Address - Street 1:109 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6441
Practice Address - Country:US
Practice Address - Phone:423-664-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000005510225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532939Medicaid
TN1532939Medicaid