Provider Demographics
NPI:1437332350
Name:HERNANDEZ, MELISSA COSENTINO (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:COSENTINO
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9101 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5022
Mailing Address - Country:US
Mailing Address - Phone:804-272-9192
Mailing Address - Fax:804-272-9257
Practice Address - Street 1:9101 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5022
Practice Address - Country:US
Practice Address - Phone:804-272-9192
Practice Address - Fax:804-272-9257
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001514225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant