Provider Demographics
NPI:1518355668
Name:HERNANDEZ, DEANNA (PTA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:CORRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16804 N 42ND AVE
Mailing Address - Street 2:#114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2779
Mailing Address - Country:US
Mailing Address - Phone:623-810-2713
Mailing Address - Fax:
Practice Address - Street 1:10133 N 92ND ST
Practice Address - Street 2:STE. 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4556
Practice Address - Country:US
Practice Address - Phone:480-584-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11216APTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant