Provider Demographics
NPI:1881209062
Name:HERNANDEZ, JORGE ELIAS (DPT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ELIAS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 BROOKE ST
Mailing Address - Street 2:
Mailing Address - City:TONTITOWN
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4382
Mailing Address - Country:US
Mailing Address - Phone:479-287-8118
Mailing Address - Fax:479-342-2876
Practice Address - Street 1:1326 CRUTCHER ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6482
Practice Address - Country:US
Practice Address - Phone:479-640-5518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist