Provider Demographics
NPI:1366800021
Name:HERRERA, JAMES J (PTA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:HERRERA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:J
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3110 SCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-2604
Mailing Address - Country:US
Mailing Address - Phone:402-429-5958
Mailing Address - Fax:
Practice Address - Street 1:3110 SCOTT CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2604
Practice Address - Country:US
Practice Address - Phone:402-429-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1377225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant