Provider Demographics
NPI:1477766350
Name:HERNANDEZ, DAVID (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 BRUNSWICK BLVD.
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1912
Mailing Address - Country:US
Mailing Address - Phone:210-274-0532
Mailing Address - Fax:
Practice Address - Street 1:639 BRUNSWICK BLVD.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1912
Practice Address - Country:US
Practice Address - Phone:210-923-2110
Practice Address - Fax:210-923-2110
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024263225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant