Provider Demographics
NPI:1972145795
Name:HERREN, DAKOTA VANCE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:VANCE
Last Name:HERREN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3708
Mailing Address - Country:US
Mailing Address - Phone:615-695-1455
Mailing Address - Fax:615-695-1483
Practice Address - Street 1:4230 HARDING PIKE STE 1000
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2098
Practice Address - Country:US
Practice Address - Phone:615-383-2693
Practice Address - Fax:615-292-9469
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist