Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT00006874 | WA |
NPI | 1093828170 |
---|---|
Provider Name | Ms. Lourdes M Herrera |
First Address | Vancouver, WA 98683-9644 |
Second Address | Vancouver, WA 98686-6432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 17/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0205240 | WA DEPT OF LABOR & INDUST (01) | WA |
8436891 | (05) | WA |
8941150 | WA DEPT OF L&I CRIME VICT (01) | WA |