Healthcare Provider Details

I. General information

NPI: 1508392994
Provider Name (Legal Business Name): JAMES HERRERO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 AIRWAY AVE
KINGMAN AZ
86409-3652
US

IV. Provider business mailing address

4714 GETTYSBURG RD
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-1211
  • Fax: 928-757-8826
Mailing address:
  • Phone: 888-735-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-13011
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: