Provider Demographics
NPI:1528843687
Name:HERRERA, DIEGO (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21142 WINDING BROOK SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5450
Mailing Address - Country:US
Mailing Address - Phone:571-251-2090
Mailing Address - Fax:
Practice Address - Street 1:11800 SUNRISE VALLEY DR STE 1
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5302
Practice Address - Country:US
Practice Address - Phone:703-709-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist