Provider Demographics
NPI:1912154790
Name:HERNANDEZ, MAUREEN (DPT/ PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DPT/ PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2108
Mailing Address - Country:US
Mailing Address - Phone:502-744-0746
Mailing Address - Fax:
Practice Address - Street 1:2141 BELMONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2108
Practice Address - Country:US
Practice Address - Phone:502-744-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005104225100000X
IN05009251A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist