Provider Demographics
NPI:1780671222
Name:HERNANDEZ, ROSA (PT)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-567-7200
Mailing Address - Fax:301-567-2728
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 430
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-7200
Practice Address - Fax:301-567-2728
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD940698100Medicaid