Provider Demographics
NPI:1750510806
Name:HERNANDEZ, MANUEL JOSE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:JOSE
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 TRAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3020
Mailing Address - Country:US
Mailing Address - Phone:915-595-3535
Mailing Address - Fax:915-595-3922
Practice Address - Street 1:2280 TRAWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3020
Practice Address - Country:US
Practice Address - Phone:915-595-3535
Practice Address - Fax:915-595-3922
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1189421OtherLICENSE NUMBER