Individual provider Active NPI

Daniel Nathan Hernandez, PT, DPT, SCS

  • Sports Physical Therapist
  • Mountain Home Afb, ID
National Provider Identifier
1750973616
Registry record updated Jan 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
License
1571196 Issued in ID
Practice address
725 Alpine St BLDG 210
Mountain Home Afb, ID 83648-5405
Phone
(254) 699-3933
NPI assigned
Feb 10, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical Therapist 2251S0007X 1571196 ID Primary

Addresses

Primary practice location

725 Alpine St BLDG 210
Mountain Home Afb, ID 83648-5405

Mailing address

133 Magnolia Ave SE
Fort Walton Beach, FL 32548-7266
Phone (850) 739-4936

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210823002113 WA Practitioner - Physical Therapist in Private Practice 9335544782 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1571196IDMDSports Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Physical Therapy Inc PS Sports CurrentSince Jul 29, 2021 Accepting new patients

Locations

214 Ash St
Grandview, WA 98930
Phone (509) 203-0959

7201 W Clearwater Ave
Ste B101
Kennewick, WA 99336
Phone (509) 544-0265

35 S Louisiana St
Ste A140
Kennewick, WA 99336
Phone (509) 582-0429

343 Wellsian Way
Richland, WA 99352
Phone (509) 547-3673

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769644800000",
    "number": "1750973616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 MAGNOLIA AVE SE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325487266",
            "telephone_number": "850-739-4936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 ALPINE ST BLDG 210",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836485405",
            "telephone_number": "254-699-3933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "DANIEL",
        "middle_name": "NATHAN",
        "credential": "PT, DPT, SCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-10",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "ID",
            "license": "1571196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home Afb, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.