Active NPI
Benjamin Stuardo Herrera
- Physical Therapy Assistant
- Lindale, TX
National Provider Identifier
1154892172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2083381
- Practice address
- 616 N Main St Ste a
Lindale, TX 75771-6426 - Phone
- (903) 882-6400
- NPI assigned
- Dec 17, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2083381 | TX | Primary |
Addresses
Primary practice location
616 N Main St Ste a
Lindale, TX 75771-6426
Mailing address
616 N Main St Ste a
Lindale, TX 75771-6426
Phone (903) 882-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2083381 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545004800000",
"number": "1154892172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "616 N MAIN ST STE A",
"city": "LINDALE",
"state": "TX",
"postal_code": "757716426",
"telephone_number": "903-882-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "616 N MAIN ST STE A",
"city": "LINDALE",
"state": "TX",
"postal_code": "757716426",
"telephone_number": "903-882-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRERA",
"first_name": "BENJAMIN",
"middle_name": "STUARDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-12-17",
"last_updated": "2018-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2083381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lindale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.