Healthcare Provider Details

I. General information

NPI: 1689094922
Provider Name (Legal Business Name): JOHN HOWARD HERMANO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CONSTITUTION AVE NE
WASHINGTON DC
20002-6058
US

IV. Provider business mailing address

2100 19TH ST NW 805
WASHINGTON DC
20009-1344
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-4800
  • Fax:
Mailing address:
  • Phone: 414-736-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT870509
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: