Healthcare Provider Details

I. General information

NPI: 1417872508
Provider Name (Legal Business Name): NICHOLAS ANTONIO HERNANDEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N GRIMES ST
HOBBS NM
88240-1816
US

IV. Provider business mailing address

2700 N GRIMES ST
HOBBS NM
88240-1816
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-4129
  • Fax: 844-292-4019
Mailing address:
  • Phone: 575-392-4129
  • Fax: 844-292-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2026-0243
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: