Provider Demographics
NPI:1093990871
Name:HERNANDEZ, HEIDI (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 SPOTTERS CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-3166
Mailing Address - Country:US
Mailing Address - Phone:410-239-4706
Mailing Address - Fax:
Practice Address - Street 1:2100 UTZ TER
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9479
Practice Address - Country:US
Practice Address - Phone:717-630-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006964L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist