MEDICARE: MR. SERGIO O HERNANDEZ PT.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	03810	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952469207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SERGIO O HERNANDEZ PT.

Provider Business Mailing Address
First Line	:	3985 STEVE REYNOLDS BLVD
Second Line	:	BLDG G.
City	:	NORCROSS
State	:	GA
Zip	:	30093-3035
Country	:	US
Telephone Number	:	770-622-2532
Fax Number	:	770-622-2534

Provider Business Practice Location Address
First Line	:	3985 STEVE REYNOLDS BLVD
Second Line	:	BLDG G.
City	:	NORCROSS
State	:	GA
Zip	:	30093-3035
Country	:	US
Telephone Number	:	770-622-2532
Fax Number	:	770-622-2534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/17/2009

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Directions to “ MR. SERGIO O HERNANDEZ PT.” Practice Location

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