Provider Demographics
NPI:1407337694
Name:ANIAG, EMMANUEL HERNANDEZ (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:HERNANDEZ
Last Name:ANIAG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 SHORTHORN DRIVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2800
Mailing Address - Country:US
Mailing Address - Phone:715-253-3743
Mailing Address - Fax:
Practice Address - Street 1:855 HUNTER DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1867
Practice Address - Country:US
Practice Address - Phone:715-253-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL00092462251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics