Provider Demographics
NPI:1457470403
Name:HERNANDEZ, MELBA MARIA (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:MELBA
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 NE 144TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2433
Mailing Address - Country:US
Mailing Address - Phone:305-778-0693
Mailing Address - Fax:
Practice Address - Street 1:1706 EAST SEMORAN BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703
Practice Address - Country:US
Practice Address - Phone:407-880-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist