Provider Demographics
NPI:1821096256
Name:FERNANDES, LENA S (MHS,PT)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:S
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:MHS,PT
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:S
Other - Last Name:SALVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHS,PT
Mailing Address - Street 1:9712 BARLOW RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3503
Mailing Address - Country:US
Mailing Address - Phone:703-980-9482
Mailing Address - Fax:703-787-3051
Practice Address - Street 1:1840 MICHAEL FARADAY DR
Practice Address - Street 2:SUITE #110
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5347
Practice Address - Country:US
Practice Address - Phone:703-980-9482
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist