Healthcare Provider Details

I. General information

NPI: 1093828170
Provider Name (Legal Business Name): LOURDES M HERRERA M.S.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 NE 20TH AVE STE 101
VANCOUVER WA
98686-6432
US

IV. Provider business mailing address

1405 SE 164TH AVE STE 102
VANCOUVER WA
98683-9644
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-9293
  • Fax: 360-574-9283
Mailing address:
  • Phone: 360-256-4425
  • Fax: 360-254-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT00006874
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: