Provider Demographics
NPI:1952916785
Name:HERNANDEZ, AMANDA BESSENT (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BESSENT
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DAWN
Other - Last Name:BESSENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6913 CAMP BOWIE BLVD STE 177
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7169
Mailing Address - Country:US
Mailing Address - Phone:682-312-7693
Mailing Address - Fax:682-708-8126
Practice Address - Street 1:6913 CAMP BOWIE BLVD STE 177
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7169
Practice Address - Country:US
Practice Address - Phone:682-312-7693
Practice Address - Fax:682-708-8126
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1336630208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation