Provider Demographics
NPI:1922366053
Name:FUENTES, JENNY LISSETTE (PT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LISSETTE
Last Name:FUENTES
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 1:6701 SUNSET DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4529
Mailing Address - Country:US
Mailing Address - Phone:305-661-7601
Mailing Address - Fax:305-661-0154
Practice Address - Street 1:6701 SUNSET DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4529
Practice Address - Country:US
Practice Address - Phone:305-661-7601
Practice Address - Fax:305-661-0154
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT166552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic