Provider Demographics
NPI:1356630891
Name:FERNANDEZ, MIDALYS (PT)
Entity Type:Individual
Prefix:
First Name:MIDALYS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 SW 75TH AVE
Mailing Address - Street 2:OUTPATIENT DEPARTMENT
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2800
Mailing Address - Country:US
Mailing Address - Phone:786-232-5015
Mailing Address - Fax:305-267-1841
Practice Address - Street 1:2525 SW 75TH AVE
Practice Address - Street 2:OUTPATIENT DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2800
Practice Address - Country:US
Practice Address - Phone:786-232-5015
Practice Address - Fax:305-267-1841
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 17990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist