Provider Demographics
NPI:1871717629
Name:HERNANDEZ, ANNA MARIE (RPT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8320
Mailing Address - Country:US
Mailing Address - Phone:442-242-4844
Mailing Address - Fax:
Practice Address - Street 1:8265 WHITE OAK AVENUE
Practice Address - Street 2:HORIZON THERAPY
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-373-1641
Practice Address - Fax:909-373-0444
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 11332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist