Provider Demographics
NPI:1053676981
Name:NUNEZ, HERVIN
Entity Type:Individual
Prefix:
First Name:HERVIN
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HERVIN
Other - Middle Name:VINCENT DE LOS REYES
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:18131 SLADE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1346
Mailing Address - Country:US
Mailing Address - Phone:301-260-2324
Mailing Address - Fax:
Practice Address - Street 1:18131 SLADE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1346
Practice Address - Country:US
Practice Address - Phone:301-260-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist