Provider Demographics
NPI:1750150983
Name:HERNANDEZ, ANGEL LUIS (PTA)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:LUIS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 BOERUM PL APT 3J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6280
Mailing Address - Country:US
Mailing Address - Phone:646-765-5566
Mailing Address - Fax:347-529-6227
Practice Address - Street 1:120 BOERUM PL APT 3J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6280
Practice Address - Country:US
Practice Address - Phone:646-765-5566
Practice Address - Fax:347-529-6227
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003891-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant