Provider Demographics
NPI:1629883137
Name:SEPULVEDA, HERNAN RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:HERNAN
Middle Name:RICHARD
Last Name:SEPULVEDA
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 1:12865 SW 211TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7441
Mailing Address - Country:US
Mailing Address - Phone:786-473-1337
Mailing Address - Fax:
Practice Address - Street 1:12865 SW 211TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7441
Practice Address - Country:US
Practice Address - Phone:786-473-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist