Provider Demographics
NPI:1619319365
Name:HERNANDEZ, LAURA YVETTE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:YVETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STATION #14, U.W.A.
Mailing Address - Street 2:THE UNIVERSITY OF WEST ALABAMA
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-0000
Mailing Address - Country:US
Mailing Address - Phone:205-652-5485
Mailing Address - Fax:
Practice Address - Street 1:STATION #14, U.W.A.
Practice Address - Street 2:THE UNIVERSITY OF WEST ALABAMA
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-0000
Practice Address - Country:US
Practice Address - Phone:205-652-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT50002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer