Provider Demographics
NPI:1750782710
Name:HERRINGTON, BRAD (PT)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:
Last Name:HERRINGTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 CHRISTOPHER CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-1057
Mailing Address - Country:US
Mailing Address - Phone:972-978-0504
Mailing Address - Fax:
Practice Address - Street 1:4724 CHRISTOPHER CT
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-1057
Practice Address - Country:US
Practice Address - Phone:972-978-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1095750225100000X
LA01890225100000X
AR1952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist