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General NPI Number Information
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NPI Number | 1114298445
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Entity Type | Individual
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Provider Name | MIGUEL I HERRERA PT
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Gender | Male
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 12170 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5578
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Country | US
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Telephone | 352-597-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 5255 KEYSVILLE AVE
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City | SPRING HILL
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State | FL
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Zip | 34608-1837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT11334
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License Number State | FL
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