Provider Demographics
NPI:1437141868
Name:HERNANDEZ, SHANE T (PT)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:T
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 VIRGINIA PKWY
Mailing Address - Street 2:STE 1015
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5520
Mailing Address - Country:US
Mailing Address - Phone:480-580-9632
Mailing Address - Fax:
Practice Address - Street 1:8380 WARREN PKWY
Practice Address - Street 2:STE 502
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4198
Practice Address - Country:US
Practice Address - Phone:214-618-8075
Practice Address - Fax:214-618-8055
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21444Medicare PIN