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Individual
MARY IRENE HERNANDEZ
Active
Individual
MARY IRENE HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT, CWS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3749
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
MEDICARE GROUP NPI NUMBER
OR
05
—
297645
—
OR
01
—
CB3544
TRAV RR GROUP PTAN NUMBER
OR
01
—
P00317115
TRAV RR PTAN NUMBER
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
08/31/2005
Last updated
11/05/2007
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