| Doctor Name: | MARY IRENE HERNANDEZ |
| NPI Number: | 1174517528 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPT, CWS |
| License Number: | 3749 |
| Business Practice Address: | 1900 Woodland Dr Coos Bay, OR - 97420 |
| Business Phone Number: | 5412675151 |
| Business Fax Number: | 5412672233 |
| Mailing Address: | 1900 Woodland Dr, COOS BAY |
| State: | OR |
| Postal Code: | 97420 |
| Phone Number: | 5412675151 |
| Fax Number: | 5412674843 |
| NPI Enumeration Date: | 08/31/2005 |
| NPI Last Update Date: | 11/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 3749 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |