Healthcare Provider Details

I. General information

NPI: 1306523428
Provider Name (Legal Business Name): ELLIOT HERNANDEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6278 BEACH DR SW STE 114
OCEAN ISLE BEACH NC
28469-3670
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 910-579-3900
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11885
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22361
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: