Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 21737 | FL |
NPI | 1013288414 |
---|---|
Provider Name | Nathan Hernandez |
First Address | Dunedin, FL 34698-8237 |
Second Address | Palm Harbor, FL 34684-4928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |