Provider Demographics
NPI:1740568112
Name:HERNANDEZ, DAWN ADELE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ADELE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12952 BANDERA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4733
Mailing Address - Country:US
Mailing Address - Phone:210-372-9600
Mailing Address - Fax:210-372-0211
Practice Address - Street 1:12952 BANDERA RD STE 107
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4733
Practice Address - Country:US
Practice Address - Phone:210-372-9600
Practice Address - Fax:210-372-0211
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1207406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist