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General NPI Number Information
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NPI Number | 1750973616
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Entity Type | Individual
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Provider Name | DANIEL NATHAN HERNANDEZ PT, DPT, SCS
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Gender | Male
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 725 ALPINE ST BLDG 210
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City | MOUNTAIN HOME AFB
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State | ID
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Zip | 83648-5405
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Country | US
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Telephone | 254-699-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 133 MAGNOLIA AVE SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-7266
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Country | US
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Telephone | 850-739-4936
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 1571196
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License Number State | ID
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