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General NPI Number Information
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NPI Number | 1528693777
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Entity Type | Individual
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Provider Name | DENISE HERNANDEZ PTA
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Gender | Female
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 311 NE 8TH ST STE 104
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City | HOMESTEAD
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State | FL
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Zip | 33030-4734
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Country | US
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Telephone | 305-248-8600
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Fax | 844-272-8151
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Provider Business Mailing Address
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Address Line | 12208 SW 251ST TER
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City | HOMESTEAD
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State | FL
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Zip | 33032-5925
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Country | US
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Telephone | 786-302-7514
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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 | PTA30112
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License Number State | FL
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