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General NPI Number Information
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NPI Number | 1891979266
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Entity Type | Organization
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Legal Business Name | HERNANDEZ THERAPEUTICS LLC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 1400 N WESTGATE DR SUITE 203
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City | WESLACO
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State | TX
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Zip | 78596-4329
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Country | US
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Telephone | 956-969-1496
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Fax | 956-969-1497
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Provider Business Mailing Address
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Address Line | 1400 N WESTGATE DR SUITE 203
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City | WESLACO
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State | TX
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Zip | 78596-4329
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Country | US
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Telephone | 956-969-1496
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Fax | 956-969-1497
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Authorized Official
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Title or Position | OWNER
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Name | DR. MODESTO HERNANDEZ III
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Credential | PT, DPT
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Telephone | 956-969-1496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 661940000
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License Number State | TX
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