Provider Demographics
NPI:1801131610
Name:HERNANDEZ TENERIFE, EMMA (PT)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:
Last Name:HERNANDEZ TENERIFE
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 1:4639 OAK MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-9476
Mailing Address - Country:US
Mailing Address - Phone:865-922-3645
Mailing Address - Fax:
Practice Address - Street 1:505 BUCHANAN ROAD
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825
Practice Address - Country:US
Practice Address - Phone:423-626-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT42182251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics