Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | A3929 | NC |
NPI | 1205224839 |
---|---|
Provider Name | Lucy Hernandez |
First Address | Charlotte, NC 28273-6909 |
Second Address | Charlotte, NC 28209-3316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 06/01/2015 |