Provider Demographics
NPI:1407114705
Name:HERNANDEZ, RUBIELA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RUBIELA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8989 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2513
Mailing Address - Country:US
Mailing Address - Phone:347-542-9215
Mailing Address - Fax:
Practice Address - Street 1:305 W 44TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-5402
Practice Address - Country:US
Practice Address - Phone:212-586-6400
Practice Address - Fax:212-397-7351
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
006199-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant