Healthcare Provider Details

I. General information

NPI: 1215701560
Provider Name (Legal Business Name): SOFIA HERNANDEZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10205 S DIXIE HWY STE 102
PINECREST FL
33156-3168
US

IV. Provider business mailing address

14720 SW 176TH ST
MIAMI FL
33187-6714
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-5971
  • Fax:
Mailing address:
  • Phone: 504-201-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: