Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1313159 | TX |
NPI | 1033773239 |
---|---|
Provider Name | Christine Hernandez |
First Address | Irving, TX 75061-2260 |
Second Address | Irving, TX 75061-2260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 24/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1313159 | TEXAS LICENSE # (01) | TX |