Healthcare Provider Details

I. General information

NPI: 1962645622
Provider Name (Legal Business Name): DASIA HERNANDEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ROCKMEAD DRIVE
KINGWOOD TX
77339
US

IV. Provider business mailing address

7401 S. MAIN FONDREN ORTHOPEDIC GROUP L.L.P.
HOUSTON TX
77030-4509
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-2663
  • Fax: 281-312-3800
Mailing address:
  • Phone: 713-799-2300
  • Fax: 713-794-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2044022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: