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General NPI Number Information
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NPI Number | 1821557315
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Entity Type | Individual
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Provider Name | WENDY LICET HERNANDEZ PTA
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Gender | Female
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 215 ANNIE ST
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City | ORLANDO
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State | FL
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Zip | 32806-1207
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Country | US
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Telephone | 407-847-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 211 ESPLANADE WAY APT 107
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City | CASSELBERRY
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State | FL
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Zip | 32707-6816
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Country | US
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Telephone | 321-295-1640
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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 | PTA28806
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License Number State | FL
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