Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2126957 | TX |
NPI | 1003324823 |
---|---|
Provider Name | Raul Hernandez |
First Address | Mcallen, TX 78503-1589 |
Second Address | Victoria, TX 77901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2018 |
Last Update Date | 14/08/2018 |