Provider Demographics
NPI:1598204091
Name:HERNANDEZ, ELIZABETH (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-1917
Mailing Address - Country:US
Mailing Address - Phone:210-385-7922
Mailing Address - Fax:
Practice Address - Street 1:806 COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-1917
Practice Address - Country:US
Practice Address - Phone:210-385-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer