Provider Demographics
NPI:1891727889
Name:HERNANDEZ, MICHAEL NORMAN (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NORMAN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 COHASSET RD
Mailing Address - Street 2:SUITE 185
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2210
Mailing Address - Country:US
Mailing Address - Phone:530-891-1366
Mailing Address - Fax:530-891-0950
Practice Address - Street 1:260 COHASSET RD
Practice Address - Street 2:SUITE 185
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2210
Practice Address - Country:US
Practice Address - Phone:530-891-1366
Practice Address - Fax:530-891-0950
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 10638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0106380Medicaid
CAPT0106380Medicaid