Provider Demographics
NPI:1487660189
Name:HERNANDEZ, ROBERTO ISIDRO JR (PT)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ISIDRO
Last Name:HERNANDEZ
Suffix:JR
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:PO BOX 532127
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2127
Mailing Address - Country:US
Mailing Address - Phone:956-428-8951
Mailing Address - Fax:956-428-0232
Practice Address - Street 1:1000 CROWNS RIDGE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852
Practice Address - Country:US
Practice Address - Phone:830-757-2497
Practice Address - Fax:830-757-0489
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G2844Medicare ID - Type Unspecified