Provider Demographics
NPI:1235411679
Name:FERNANDEZ, AMANDA ERIN (DPT, MPH, CSCS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ERIN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DPT, MPH, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 SOUTHBAY DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3920 BEE RIDGE RD UNIT S
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-867-7463
Practice Address - Fax:941-870-3839
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62341225100000X
FLPT267012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist