Provider Demographics
NPI:1346977352
Name:FT NERVE GROUP PLLC
Entity Type:Organization
Organization Name:FT NERVE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERDRO
Authorized Official - Middle Name:ARLISS
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-887-9610
Mailing Address - Street 1:770 E MAIN ST STE 356
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2293
Mailing Address - Country:US
Mailing Address - Phone:801-973-1373
Mailing Address - Fax:
Practice Address - Street 1:476 N 900 W STE B
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-5201
Practice Address - Country:US
Practice Address - Phone:801-973-1373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty