Provider Demographics
NPI:1902057367
Name:HERRERA, DANETTE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 S DESOTO ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3621
Mailing Address - Country:US
Mailing Address - Phone:352-220-4928
Mailing Address - Fax:352-746-3554
Practice Address - Street 1:39 S DESOTO ST
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3621
Practice Address - Country:US
Practice Address - Phone:352-220-4928
Practice Address - Fax:352-746-3554
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLPTA18626225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant