Provider Demographics
NPI:1720254303
Name:HERRERA, EVELYN C (MS PT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:C
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MS PT
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Mailing Address - Street 1:11150 75TH RD APT 31A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6335
Mailing Address - Country:US
Mailing Address - Phone:917-972-3463
Mailing Address - Fax:718-263-2308
Practice Address - Street 1:636 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2607
Practice Address - Country:US
Practice Address - Phone:917-972-3463
Practice Address - Fax:844-259-0167
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2018-03-21
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Provider Licenses
StateLicense IDTaxonomies
NY024497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist