Provider Demographics
NPI:1316226004
Name:MOORE, MARCELINA HERNANDEZ (PTA)
Entity Type:Individual
Prefix:
First Name:MARCELINA
Middle Name:HERNANDEZ
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MARCELINA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 N KING ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5008
Mailing Address - Country:US
Mailing Address - Phone:830-303-8631
Mailing Address - Fax:830-303-8541
Practice Address - Street 1:419 N KING ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5008
Practice Address - Country:US
Practice Address - Phone:830-303-8631
Practice Address - Fax:830-303-8541
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2033793225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant