Healthcare Provider Details

I. General information

NPI: 1457470403
Provider Name (Legal Business Name): MELBA MARIA HERNANDEZ MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 EAST SEMORAN BLVD SUITE 107
APOPKA FL
32703
US

IV. Provider business mailing address

1105 NE 144TH ST
NORTH MIAMI FL
33161-2433
US

V. Phone/Fax

Practice location:
  • Phone: 407-880-7772
  • Fax:
Mailing address:
  • Phone: 305-778-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: