Provider Demographics
NPI:1932453321
Name:HERNANDEZ, JASON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 AGORA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1383
Mailing Address - Country:US
Mailing Address - Phone:210-658-8483
Mailing Address - Fax:210-658-0828
Practice Address - Street 1:9160 GUILBEAU RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-3080
Practice Address - Country:US
Practice Address - Phone:210-764-3600
Practice Address - Fax:210-764-3150
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1224336208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation