Provider Demographics
NPI:1720261183
Name:HERRING PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HERRING PHYSICAL THERAPY, LLC
Other - Org Name:HERRING THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BENTON
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:480-236-1138
Mailing Address - Street 1:1955 W BASELINE RD
Mailing Address - Street 2:SUITE 113-613
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9003
Mailing Address - Country:US
Mailing Address - Phone:480-236-1138
Mailing Address - Fax:602-235-0937
Practice Address - Street 1:1955 W BASELINE RD
Practice Address - Street 2:SUITE 113-613
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9003
Practice Address - Country:US
Practice Address - Phone:480-236-1138
Practice Address - Fax:602-235-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104667Medicare PIN