Provider Demographics
NPI:1265896187
Name:HERNANDEZ, JESSICA FRASER (PT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:FRASER
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 1:2701 AIRLINE DR STE L
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7213
Mailing Address - Country:US
Mailing Address - Phone:504-229-6845
Mailing Address - Fax:
Practice Address - Street 1:2701 AIRLINE DR STE L
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7213
Practice Address - Country:US
Practice Address - Phone:504-229-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist