Provider Demographics
NPI:1629660105
Name:FERNANDEZ LEGRA, DELIA CARIDAD (PTA)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:CARIDAD
Last Name:FERNANDEZ LEGRA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13721 SW 149TH CIRCLE LN APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8239
Mailing Address - Country:US
Mailing Address - Phone:305-934-3671
Mailing Address - Fax:
Practice Address - Street 1:13721 SW 149TH CIRCLE LN APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8239
Practice Address - Country:US
Practice Address - Phone:305-934-3671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28436225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant