Provider Demographics
NPI:1841959913
Name:HERNANDEZ CASANOVA, HAYZQUEL COROMOTO (LPTA)
Entity type:Individual
Prefix:
First Name:HAYZQUEL
Middle Name:COROMOTO
Last Name:HERNANDEZ CASANOVA
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:HAYZQUEL
Other - Middle Name:COROMOTO
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7908 JOHN ADAMS CT APT 102
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6579
Mailing Address - Country:US
Mailing Address - Phone:804-247-8131
Mailing Address - Fax:
Practice Address - Street 1:7120 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6007
Practice Address - Country:US
Practice Address - Phone:703-256-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605316225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant