Healthcare Provider Details

I. General information

NPI: 1992028328
Provider Name (Legal Business Name): COLIN RICHARD HERLIHY MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 CHIHUAHUA ST SUITE#3
LAREDO TX
78043-3657
US

IV. Provider business mailing address

2108 CHIHUAHUA ST SUITE#3
LAREDO TX
78043-3657
US

V. Phone/Fax

Practice location:
  • Phone: 956-568-4571
  • Fax: 956-568-4671
Mailing address:
  • Phone: 956-568-4571
  • Fax: 956-568-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1189480
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: