Healthcare Provider Details

I. General information

NPI: 1184332694
Provider Name (Legal Business Name): KATHERIN HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 SW 24TH ST STE 205
MIAMI FL
33155-2305
US

IV. Provider business mailing address

11800 SW 18TH ST APT 323
MIAMI FL
33175-1659
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6868
  • Fax:
Mailing address:
  • Phone: 305-924-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: