Provider Demographics
NPI:1417430562
Name:FERNICOLA, JOSEPH GREGORY (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GREGORY
Last Name:FERNICOLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 N RODNEY PARHAM RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4158
Mailing Address - Country:US
Mailing Address - Phone:501-225-0111
Mailing Address - Fax:501-613-0886
Practice Address - Street 1:11121 N RODNEY PARHAM RD STE 2A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4158
Practice Address - Country:US
Practice Address - Phone:501-225-0111
Practice Address - Fax:501-613-0886
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist