Provider Demographics
NPI:1518526243
Name:HERNANDEZ III, MARIO III (DPT)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:HERNANDEZ III
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SW 146TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1997
Mailing Address - Country:US
Mailing Address - Phone:206-630-3000
Mailing Address - Fax:844-660-0682
Practice Address - Street 1:140 SW 146TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1997
Practice Address - Country:US
Practice Address - Phone:206-630-3000
Practice Address - Fax:844-660-0682
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61138787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist