Provider Demographics
NPI:1720254303
Name:HERRERA, EVELYN C (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:C
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 DEAN ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1980
Mailing Address - Country:US
Mailing Address - Phone:917-972-3463
Mailing Address - Fax:718-263-2308
Practice Address - Street 1:957-963 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:917-670-5261
Practice Address - Fax:718-263-2308
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist