Provider Demographics
NPI:1992028328
Name:HERLIHY, COLIN RICHARD (MPT)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:RICHARD
Last Name:HERLIHY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 CHIHUAHUA ST
Mailing Address - Street 2:SUITE#3
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3657
Mailing Address - Country:US
Mailing Address - Phone:956-568-4571
Mailing Address - Fax:956-568-4671
Practice Address - Street 1:2108 CHIHUAHUA ST
Practice Address - Street 2:SUITE#3
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3657
Practice Address - Country:US
Practice Address - Phone:956-568-4571
Practice Address - Fax:956-568-4671
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist