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General NPI Number Information
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NPI Number | 1285246942
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Entity Type | Individual
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Provider Name | LARRY HERNANDEZ LPTA
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Gender | Male
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 888 S GREENVILLE AVE STE 207
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City | RICHARDSON
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State | TX
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Zip | 75081-5044
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Country | US
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Telephone | 972-899-3473
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Fax | 469-784-9424
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Provider Business Mailing Address
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Address Line | 4214 HIGH STAR LN
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City | DALLAS
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State | TX
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Zip | 75287-6624
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Country | US
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Telephone | 972-603-8953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2058565
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License Number State | TX
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