Provider Demographics
NPI:1629383807
Name:HERNANDEZ LUNA, EMMANUEL (PTA)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:HERNANDEZ LUNA
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 1:30123 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1223
Mailing Address - Country:US
Mailing Address - Phone:440-364-6479
Mailing Address - Fax:
Practice Address - Street 1:3310 WARREN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2031
Practice Address - Country:US
Practice Address - Phone:216-476-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07718225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant