MEDICARE: BRENDA MARIE HERRERA-WOLF PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1041432	TX
2	2251X0800X	Orthopedic Physical Therapist	1041432	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00J21A	OTHER	TX	GROUP MEDICARE PIN NUMBER

General Provider Information

NPI Number	:	1326371576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MARIE HERRERA-WOLF PT

Provider Business Mailing Address
First Line	:	17270 RED OAK DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77090-2618
Country	:	US
Telephone Number	:	281-440-6960
Fax Number	:

Provider Business Practice Location Address
First Line	:	17270 RED OAK DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77090-2618
Country	:	US
Telephone Number	:	281-440-6960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	05/24/2022

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