MEDICARE: MARK HERRERA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1271369	TX

General Provider Information

NPI Number	:	1982066874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK HERRERA DPT

Provider Business Mailing Address
First Line	:	PO BOX 306393
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6393
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	1300 DACY LN STE 100
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-4194
Country	:	US
Telephone Number	:	512-213-8001
Fax Number	:	512-436-0874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	07/22/2020

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