Provider Demographics
NPI:1285246942
Name:HERNANDEZ, LARRY (LPTA)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 HIGH STAR LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6624
Mailing Address - Country:US
Mailing Address - Phone:972-603-8953
Mailing Address - Fax:
Practice Address - Street 1:888 S GREENVILLE AVE STE 207
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5044
Practice Address - Country:US
Practice Address - Phone:972-899-3473
Practice Address - Fax:469-784-9424
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058565225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant