Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1265171 | TX |
NPI | 1497136725 |
---|---|
Provider Name | Adrianna Hernandez |
First Address | San Antonio, TX 78240-1680 |
Second Address | San Antonio, TX 78240-1680 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 04/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
439340YM9J | MEDICARE ID (01) | TX |