Provider Demographics
NPI:1790958833
Name:DEFERNANDES, MARIA ELENA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:DEFERNANDES
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:BELLEFROIDLUNET 10F
Mailing Address - Street 2:
Mailing Address - City:MAASTRICHT
Mailing Address - State:LIMBURG
Mailing Address - Zip Code:6221KN
Mailing Address - Country:NL
Mailing Address - Phone:3143-321-1080
Mailing Address - Fax:
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist