Provider Demographics
NPI:1972178655
Name:HERNANDEZ, VICTORIA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
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 1:1631 BENTIN DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2787
Mailing Address - Country:US
Mailing Address - Phone:407-267-5657
Mailing Address - Fax:
Practice Address - Street 1:1045 RIVERSIDE AVE STE 190
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4189
Practice Address - Country:US
Practice Address - Phone:904-647-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist