Healthcare Provider Details

I. General information

NPI: 1679292973
Provider Name (Legal Business Name): DOUGLAS ALLAN HERRON MPT, PT, CLT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N ARLINGTON AVE STE 350
RENO NV
89503-4448
US

IV. Provider business mailing address

645 N ARLINGTON AVE STE 350
RENO NV
89503-4448
US

V. Phone/Fax

Practice location:
  • Phone: 775-530-4353
  • Fax:
Mailing address:
  • Phone: 775-530-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number1244
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: