Provider Demographics
NPI:1891979266
Name:HERNANDEZ THERAPEUTICS LLC
Entity type:Organization
Organization Name:HERNANDEZ THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MODESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:956-969-1496
Mailing Address - Street 1:1400 N WESTGATE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4329
Mailing Address - Country:US
Mailing Address - Phone:956-969-1496
Mailing Address - Fax:956-969-1497
Practice Address - Street 1:1400 N WESTGATE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4329
Practice Address - Country:US
Practice Address - Phone:956-969-1496
Practice Address - Fax:956-969-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661940000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy