Provider Demographics
NPI:1952058695
Name:HERRERA, ALEX BENJAMIN (DPT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:BENJAMIN
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LILLY RD NE STE 240
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5117
Mailing Address - Country:US
Mailing Address - Phone:360-413-3850
Mailing Address - Fax:360-359-4726
Practice Address - Street 1:615 LILLY RD NE STE 240
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5117
Practice Address - Country:US
Practice Address - Phone:360-413-3850
Practice Address - Fax:360-359-4726
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61241145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist