Provider Demographics
NPI:1881649903
Name:BRINIS-FERNANDEZ, ILEANA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:BRINIS-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 1:1944 NW 169TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2036
Mailing Address - Country:US
Mailing Address - Phone:305-613-8958
Mailing Address - Fax:
Practice Address - Street 1:12596 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1766
Practice Address - Country:US
Practice Address - Phone:954-620-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist