Provider Demographics
NPI:1609605666
Name:HERNANDEZ, MICHAEL AUSTIN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AUSTIN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 NW MERCHANT WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5466
Mailing Address - Country:US
Mailing Address - Phone:541-797-5800
Mailing Address - Fax:541-249-5103
Practice Address - Street 1:3052 NW MERCHANT WAY STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-5466
Practice Address - Country:US
Practice Address - Phone:541-797-5800
Practice Address - Fax:541-249-5103
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist