Provider Demographics
NPI:1649212762
Name:HERNANDEZ, ALEXANDER G (PT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:G
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:AL
Other - Middle Name:G
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:315 75TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3201
Mailing Address - Country:US
Mailing Address - Phone:941-761-1998
Mailing Address - Fax:941-748-8484
Practice Address - Street 1:4110 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1719
Practice Address - Country:US
Practice Address - Phone:941-748-8383
Practice Address - Fax:941-748-8484
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6294OtherBCBS INDIV PROV NUM
FL2103654OtherFIRST HEALTH INDIV PROV #
FL890853200Medicaid
Y6294UMedicare PIN
FLY6294XMedicare PIN