Provider Demographics
NPI:1790266088
Name:HERNANDEZ, ARMANDO JR (PTA)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
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 1:421 S BONNER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2330
Mailing Address - Country:US
Mailing Address - Phone:903-586-9871
Mailing Address - Fax:
Practice Address - Street 1:421 S BONNER ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2330
Practice Address - Country:US
Practice Address - Phone:903-586-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2130941225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant