Provider Demographics
NPI:1871890350
Name:HERRO, ALICE MARGARET (PT)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MARGARET
Last Name:HERRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3516
Mailing Address - Country:US
Mailing Address - Phone:631-878-4545
Mailing Address - Fax:631-878-4573
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3516
Practice Address - Country:US
Practice Address - Phone:631-878-4545
Practice Address - Fax:631-878-4573
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR 50175Medicare UPIN
NYQ55291Medicare PIN