Provider Demographics
NPI:1003324823
Name:HERNANDEZ, RAUL (PTA)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S JACKSON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1589
Mailing Address - Country:US
Mailing Address - Phone:956-630-4400
Mailing Address - Fax:956-630-4447
Practice Address - Street 1:101 W GOODWIN AVE STE 600
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-576-0694
Practice Address - Fax:361-576-5884
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2126957225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant